Nab-Paclitaxel and Radiation Therapy in Improving and Maintaining Ambulation in Cancer Patients with Spinal Cord Compression

Inclusion Criteria

• Patients with =< 37 points per the scoring system listed in the protocol
• Histologically or cytologically confirmed diagnosis of cancer not of central nervous system (CNS) or spinal column origin
• Magnetic resonance imaging (MRI) or computed tomography (CT) evidence of metastatic epidural spinal cord compression
• Patients who have started 30 Gy in 10 fractions are not excluded as long as 4 doses of chemotherapy could potentially be given. This means the latest nab-paclitaxel can start is the morning of the third fraction of radiotherapy. Radiotherapy should ideally be delivered at least 6 hours after the nab-paclitaxel infusion started
• Absolute neutrophil count >= 1,500 cells/mm^3
• Platelets >= 100,000 cells/mm^3 (transfusion independent, defined as not receiving platelet transfusions within 7 days prior to blood draw)
• Hemoglobin > 9.0 g/dL
• Total bilirubin =< 1.5 mg/dL
• Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x institutional upper limit of normal (IULN)
• Alkaline phosphatase =< 2.5 x IULN (unless bone metastasis is present [< 5 x IULN] in the absence of liver metastasis)
• Creatinine =< 1.5 mg/dL
• Women of childbearing potential (defined as a sexually mature woman who (1) has not undergone hysterectomy or bilateral oophorectomy or (2) has not been naturally postmenopausal for at least 24 consecutive months) must: * Either commit to true abstinence from heterosexual contact (which must be reviewed on a monthly basis) or agree to use, and be able to comply with, effective contraception without interruption, 28 days prior to starting treatment with nab-paclitaxel and while on study; and * Have a negative serum pregnancy test result at screening and agree to ongoing pregnancy testing during the course of the study and after the end of study therapy. This applies even if the subject practices true abstinence from heterosexual contact
• Male subjects must practice true abstinence or agree to use a condom during sexual contact with a pregnant female or a female of childbearing potential while participating in the study, during dose interruptions, and for 6 months following nab-paclitaxel discontinuation, even if he has undergone a successful vasectomy
• Ability to understand and willingness to sign an Institutional Review Board (IRB) approved written informed consent document (or that of legally authorized representative, if applicable)

Exclusion Criteria

• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, or cardiac arrhythmia
• Pregnant and/or breastfeeding. Women of childbearing potential must have a negative serum pregnancy test prior to study entry
• Known human immunodeficiency virus (HIV)-positivity on combination antiretroviral therapy because of the potential for pharmacokinetic interactions with nab-paclitaxel. In addition, these patients are at increased risk of lethal infections when treated with marrow-suppressive therapy. Appropriate studies will be undertaken in patients receiving combination antiretroviral therapy when indicated
• Previous spinal cord radiotherapy that would overlap with the proposed treatment field
• Spinal instability or bony retropulsion causing the cord compression. That is, mechanical, not tumor, cord compression. In these cases surgery may be indicated
• Patients eligible for surgical decompression like laminectomy