Combination Chemotherapy in Treating Children With Newly Diagnosed Malignant Germ Cell Tumors
Childhood Germ Cell Tumor, Extragonadal Germ Cell Tumor
About this trial
This is an interventional treatment trial for Childhood Germ Cell Tumor focused on measuring childhood teratoma, childhood extragonadal germ cell tumor
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed newly diagnosed extracranial germ cell tumors, including 1 of the following types: Yolk sac carcinoma (endodermal sinus tumor) Embryonal carcinoma Choriocarcinoma Teratoma with mixed malignant elements (malignant teratoma) High-risk disease, defined as stage III or IV extragonadal germ cell tumors Must be enrolled on study within 21 days of diagnostic surgical procedure PATIENT CHARACTERISTICS: Age 21 and under (at original diagnosis) Performance status ECOG 0-2 Karnofsky 50-100% (in patients over 16 years of age) Lansky 50-100% (in patients 16 years of age and under) Life expectancy At least 2 months Hematopoietic Absolute neutrophil count at least 1,000/mm^3 Platelet count at least 100,000/mm^3 (transfusion independent) Hemoglobin at least 10.0 g/dL (transfusion allowed) Hepatic Not specified Renal Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min OR Creatinine based on age as follows: No greater than 0.8 mg/dL (5 years and under) No greater than 1.0 mg/dL (6-10 years) No greater than 1.2 mg/dL (11-15 years) No greater than 1.5 mg/dL (over 15 years) Pulmonary FEV_1/FVC greater than 60% OR Children who are uncooperative must meet all of the following criteria: No dyspnea at rest No exercise intolerance Pulse oximetry greater than 94% Other Not pregnant or nursing Fertile patients must use effective contraception PRIOR CONCURRENT THERAPY: Biologic therapy Not specified Chemotherapy No prior chemotherapy Endocrine therapy Not specified Radiotherapy No prior radiotherapy Surgery See Disease Characteristics
Sites / Locations
- Comprehensive Cancer Center at University of Alabama at Birmingham
- Phoenix Children's Hospital
- Arkansas Cancer Research Center at University of Arkansas for Medical Sciences
- Southern California Permanente Medical Group
- Loma Linda University Cancer Institute at Loma Linda University Medical Center
- Children's Hospital Los Angeles
- Children's Hospital Central California
- Children's Hospital of Orange County
- Kaiser Permanente Medical Center - Oakland
- Children's Hospital and Health Center - San Diego
- Stanford Cancer Center at Stanford University Medical Center
- Children's Hospital Cancer Center
- Alfred I. duPont Hospital for Children
- Children's National Medical Center
- Lee Cancer Care of Lee Memorial Health System
- University of Florida Shands Cancer Center
- Nemours Children's Clinic
- University of Miami Sylvester Comprehensive Cancer Center
- Miami Children's Hospital
- Baptist-South Miami Regional Cancer Program
- Sacred Heart Cancer Center at Sacred Heart Hospital
- All Children's Hospital
- St. Joseph's Cancer Institute at St. Joseph's Hospital
- Kaplan Cancer Center at St. Mary's Medical Center
- Emory University Hospital - Atlanta
- Cancer Research Center of Hawaii
- Children's Memorial Hospital - Chicago
- Saint Jude Midwest Affiliate
- Southern Illinois University School of Medicine
- St. Vincent Indianapolis Hospital
- Kansas Masonic Cancer Research Institute at the University of Kansas Medical Center
- Markey Cancer Center at University of Kentucky Chandler Medical Center
- CancerCare of Maine at Eastern Maine Medial Center
- Alvin and Lois Lapidus Cancer Institute at Sinai Hospital
- Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute
- C.S. Mott Children's Hospital at University of Michigan
- Barbara Ann Karmanos Cancer Institute
- Hurley Medical Center
- Spectrum Health Cancer Care - Butterworth Campus
- Van Elslander Cancer Center at St. John Hospital and Medical Center
- Breslin Cancer Center at Ingham Regional Medical Center
- Children's Hospital of Minnesota - Minneapolis
- Fairview University Medical Center - University Campus
- Mayo Clinic Cancer Center
- University of Mississippi Medical Center
- Ellis Fischel Cancer Center at University of Missouri - Columbia
- Children's Mercy Hospital
- Siteman Cancer Center at Barnes-Jewish Hospital
- Hackensack University Medical Center Cancer Center
- St. Barnabas Medical Center
- Albert Einstein Cancer Center at Albert Einstein College of Medicine
- James P. Wilmot Cancer Center at University of Rochester Medical Center
- SUNY Upstate Medical University Hospital
- New York Medical College
- Blumenthal Cancer Center at Carolinas Medical Center
- Presbyterian Cancer Center at Presbyterian Hospital
- Duke Comprehensive Cancer Center
- Children's Hospital Medical Center of Akron
- Cincinnati Children's Hospital Medical Center
- Children's Medical Center - Dayton
- Tod Children's Hospital - Forum Health
- Oklahoma University Medical Center
- Penn State Cancer Institute at Milton S. Hershey Medical Center
- Children's Hospital of Philadelphia
- St. Christopher's Hospital for Children
- Hollings Cancer Center at Medical University of South Carolina
- Greenville Hospital System Cancer Center
- East Tennessee Children's Hospital
- St. Jude Children's Research Hospital
- Texas Tech University Health Sciences Center School of Medicine
- Children's Hospital of Austin
- Driscoll Children's Hospital
- Medical City Dallas Hospital
- Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas
- Cook Children's Medical Center - Fort Worth
- Baylor University Medical Center - Houston
- M.D. Anderson Cancer Center at University of Texas
- Covenant Children's Hospital
- University of Texas Health Science Center at San Antonio
- Methodist Children's Hospital of South Texas
- Primary Children's Medical Center
- INOVA Fairfax Hospital
- Carilion Cancer Center of Western Virginia
- West Virginia University - Robert C. Byrd Health Sciences Center - Charleston Division
- St. Vincent Hospital Regional Cancer Center
- University of Wisconsin Comprehensive Cancer Center
- Marshfield Clinic - Marshfield Center
- Midwest Children's Cancer Center
- Princess Margaret Hospital for Children
- Children's & Women's Hospital of British Columbia
- Janeway Children's Health and Rehabilitation Centre
- McMaster Children's Hospital at Hamilton Health Sciences
- Hospital for Sick Children
- Montreal Children's Hospital at McGill University Health Center
- Hopital Sainte Justine
- Centre Hospitalier Universitaire de Quebec
- Allan Blair Cancer Centre at Pasqua Hospital
- San Jorge Children's Hospital
Arms of the Study
Arm 1
Experimental
combination chemotherapy
Induction therapy: bleomycin sulfate IV over 10-20 minutes on day 1, etoposide IV over 1 hour and cisplatin IV over 4 hours on days 1-5, and cyclophosphamide IV over 1 hour on day 1. MESNA & Filgrastim (G-CSF) subcutaneously once daily beginning on day 6 and continuing until blood counts recover. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. 6 patients receive escalating doses of cyclophosphamide until the maximum tolerated dose (MTD) is determined. Evaluated after 4 courses of therapy. Partial response or stable disease undergo second-look conventional surgery & receive 2 more courses of induction therapy then re-evaluated. Those who do not achieve complete response (CR) after a total of 6 courses may undergo a third conventional surgery. Tumor that cannot be removed are removed from study therapy. Achievement of a CR at anytime are followed monthly for 1 year, every 6 months for 1 year, and then annually for 3 years.