Tocilizumab in Treating Children and Adolescents with Newly-Diagnosed, Recurrent, or Progressive Adamantinomatous Craniopharyngioma

Inclusion Criteria

• PHASE 0: Tumor biopsy/resection and/or cyst aspiration planned for the clinical care of the patient independent of study participation by the treating pediatric neurosurgeon and neuro-oncologist
• PHASE 0: Must meet one of the following criteria: * Presumed craniopharyngioma based on imaging features and best judgement of treating medical team (if newly diagnosed) * Previous histologically confirmed ACP that has progressed or recurred at the time of enrollment
• FEASIBILITY: Must meet one of the following criteria: * Recurrent or progressive ACP treated with surgery alone without radiation * Recurrent or progressive ACP treated with surgery and radiation * Newly diagnosed, by histology or imaging, ACP with unresectable residual cystic and/or solid disease that is measurable in 2 dimensions ** Progressive disease for eligibility purposes will be defined as follows: *** Solid disease: any growth deemed progression based on discretion of the investigator regardless of timing from radiation therapy (RT) *** Cystic disease: must be at least 6 months from last day of RT. Patients demonstrating isolated cyst growth > 6 months after RT must show a continued increase in the cystic component on two serial MRI scans performed at least 4 weeks apart OR at least partial reaccumulation of the cyst following one or more cyst aspirations
• FEASIBILITY: Subjects who participated in the Phase 0 portion and meet eligibility, may enroll in the Feasibility Phase of the study once open
• Age: >= 2 years and < 21 years
• Subjects may have received prior tocilizumab or other IL6 or IL6R inhibitor
• Platelet count >= 100,000/ul (transfusion independent)
• Absolute neutrophil count (ANC) >= 1500/ul
• Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 ml/min/1.73 m^2 or a serum creatinine based on age/gender as follows: * Age: 3 to < 6 years: maximum serum creatinine (mg/dL) 0.8 (male); 0.8 (female) * Age: 6 to < 10 years: maximum serum creatinine (mg/dL) 1 (male); 1 (female) * Age: 10 to < 13 years: maximum serum creatinine (mg/dL) 1.2 (male); 1.2 (female) * Age: 13 to < 16 years: maximum serum creatinine (mg/dL) 1.5 (male); 1.4 (female) * Age: 16 years to < 18 years: maximum serum creatinine (mg/dL) 1.7 (male); 1.4 (female)
• Serum glutamic-oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) and serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) < 1.5 x upper limit of normal (ULN) for age
• Eastern Cooperative Oncology Group (ECOG) performance status scores of 0, 1, or 2
• Karnofsky score of >= 60 for patients > 16 years of age; or
• Lansky score of >= 60 for patients =< 16 years of age
• Subjects of childbearing or child fathering potential must be willing to use a medically acceptable form of birth control, which includes abstinence, while being treated on this study
• Informed consent and assent obtained as appropriate

Exclusion Criteria

• Pregnant or breastfeeding
• Uncontrolled intercurrent illness including, but not limited to: * Ongoing or active infection (including active tuberculosis) * Symptomatic congestive heart failure * Unstable angina pectoris * Cardiac arrhythmia * Psychiatric illness/social situations that would limit compliance with study requirements are not eligible
• Known hypersensitivity or history of anaphylaxis to tocilizumab
• Received any live vaccinations within 3 months prior to start of therapy
• Evidence of metastatic disease or other cancer
• Inability to return for follow up visits or obtain required follow-up studies to assess toxicity of therapy