Combination Chemotherapy in Treating Young Patients With Recurrent or Resistant Malignant Germ Cell Tumors
Childhood Extracranial Germ Cell Tumor, Childhood Extragonadal Malignant Germ Cell Tumor, Childhood Malignant Ovarian Germ Cell Tumor
About this trial
This is an interventional treatment trial for Childhood Extracranial Germ Cell Tumor
Eligibility Criteria
Inclusion Criteria:
Histologically confirmed (at original diagnosis) extracranial germ cell tumor (GCT) containing 1 of the following malignant elements:
- Yolk sac tumor (endodermal sinus tumor)
- Choriocarcinoma
- Embryonal carcinoma
Meets 1 of the following disease criteria:
- Recurrent malignant disease
- Chemotherapy-resistant disease
- Relapsed disease
- Disease refractory to conventional therapy
- Measurable disease
- Must have received a prior first-line chemotherapy regimen that included cisplatin
- Patients with tumor marker (AFP and/or BHCG) elevation alone or bone scan findings alone are not eligible*
- Patients with immature teratoma (any grade), germinoma, sex-cord stromal tumors, or recurrent GCT previously treated with surgery alone are not eligible
- Karnofsky performance status (PS) 50-100% (age > 16 years) OR Lansky PS 50-100% (age ≤ 16 years) OR ECOG PS 0-2
- Life expectancy ≥ 8 weeks
- Absolute neutrophil count ≥ 750/mm³
- Platelet count ≥ 75,000/mm³ (transfusion independent)
Creatinine clearance or radioisotope glomerular filtration rate ≥ 70 mL/min OR creatinine normal based on age/gender, as defined by the following:
- ≤ 0.4 mg/dL (1 month to < 6 months of age)
- ≤ 0.5 mg/dL (6 months to < 1 year of age)
- ≤ 0.6 mg/dL (1 to < 2 years of age)
- ≤ 0.8 mg/dL (2 to < 6 years of age)
- ≤ 1.0 mg/dL (6 to < 10 years of age)
- ≤ 1.2 mg/dL (10 to < 13 years of age)
- ≤ 1.4 mg/dL (13 to ≥ 16 years of age) (female)
- ≤ 1.5 mg/dL (13 to < 16 years of age) (male)
- ≤ 1.7 mg/dL (≥ 16 years of age) (male)
- Bilirubin ≤ 1.5 times upper limit of normal (ULN) for age
- ALT < 2.5 times ULN for age
- Shortening fraction ≥ 27% by echocardiogram OR ejection fraction ≥ 50% by gated radionuclide study
- No dyspnea at rest
- No exercise intolerance
- Pulse oximetry > 94% (if there is clinical indication for determination)
- Patients with seizure disorder are eligible provided they are on non-enzyme inducing anticonvulsants and seizures are well controlled
- No CNS toxicity > grade 2
- No active graft-versus-host disease
- No allergy to Cremophor EL or castor oil
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- No other concurrent chemotherapy or immunomodulating agents
- Recovered from prior chemotherapy, immunotherapy, or radiotherapy
- At least 1 week since prior growth factors (2 weeks for pegfilgrastim)
- At least 1 week since prior biologic therapy
- At least 2 weeks since prior myelosuppressive chemotherapy (4 weeks for nitrosourea)
- At least 2 weeks since prior local palliative radiotherapy (i.e., small port)
- At least 6 months since prior craniospinal radiotherapy or radiotherapy to ≥ 50% of pelvis
- At least 6 weeks since other prior substantial bone marrow radiotherapy
- At least 6 months since prior allogeneic stem cell transplantation
- Concurrent radiotherapy to localized painful lesions allowed provided at least 1 measurable lesion is not irradiated
Sites / Locations
- The University of Arizona Medical Center-University Campus
- University of Arkansas for Medical Sciences
- Kaiser Permanente Downey Medical Center
- Miller Children's and Women's Hospital Long Beach
- Children's Hospital Los Angeles
- Cedars Sinai Medical Center
- Lucile Packard Children's Hospital Stanford University
- UCSF Medical Center-Mount Zion
- UCSF Medical Center-Parnassus
- Harbor-University of California at Los Angeles Medical Center
- Children's Hospital Colorado
- Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center
- University of Connecticut
- Connecticut Children's Medical Center
- Alfred I duPont Hospital for Children
- MedStar Georgetown University Hospital
- Children's National Medical Center
- Lee Memorial Health System
- Nemours Children's Clinic-Jacksonville
- University of Miami Miller School of Medicine-Sylvester Cancer Center
- Florida Hospital Orlando
- Nemours Children's Clinic - Orlando
- Nemours Children's Clinic - Pensacola
- Sacred Heart Hospital
- Johns Hopkins All Children's Hospital
- Saint Joseph's Hospital/Children's Hospital-Tampa
- Saint Mary's Hospital
- Children's Healthcare of Atlanta - Egleston
- Emory University Hospital/Winship Cancer Institute
- University of Hawaii Cancer Center
- Lurie Children's Hospital-Chicago
- University of Illinois
- Advocate Children's Hospital-Oak Lawn
- Saint Jude Midwest Affiliate
- Indiana University/Melvin and Bren Simon Cancer Center
- Riley Hospital for Children
- University of Kentucky/Markey Cancer Center
- Norton Children's Hospital
- Tulane University Health Sciences Center
- Children's Hospital New Orleans
- Sinai Hospital of Baltimore
- Johns Hopkins University/Sidney Kimmel Cancer Center
- Massachusetts General Hospital Cancer Center
- Dana-Farber Cancer Institute
- Helen DeVos Children's Hospital at Spectrum Health
- Spectrum Health at Butterworth Campus
- Children's Hospitals and Clinics of Minnesota - Minneapolis
- University of Mississippi Medical Center
- The Childrens Mercy Hospital
- Hackensack University Medical Center
- Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital
- Saint Joseph's Regional Medical Center
- Overlook Hospital
- University of New Mexico Cancer Center
- Albany Medical Center
- Montefiore Medical Center - Moses Campus
- Columbia University/Herbert Irving Cancer Center
- State University of New York Upstate Medical University
- UNC Lineberger Comprehensive Cancer Center
- Carolinas Medical Center/Levine Cancer Institute
- Sanford Broadway Medical Center
- Children's Hospital Medical Center of Akron
- Cincinnati Children's Hospital Medical Center
- Rainbow Babies and Childrens Hospital
- Cleveland Clinic Foundation
- Nationwide Children's Hospital
- Dayton Children's Hospital
- University of Oklahoma Health Sciences Center
- Penn State Milton S Hershey Medical Center
- Penn State Children's Hospital
- Children's Hospital of Pittsburgh of UPMC
- Medical University of South Carolina
- Palmetto Health Richland
- East Tennessee Childrens Hospital
- St. Jude Children's Research Hospital
- Driscoll Children's Hospital
- Medical City Dallas Hospital
- Cook Children's Medical Center
- Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
- Covenant Children's Hospital
- Methodist Children's Hospital of South Texas
- University of Texas Health Science Center at San Antonio
- Children's Hospital of The King's Daughters
- Carilion Clinic Children's Hospital
- West Virginia University Charleston Division
- Princess Margaret Hospital for Children
- University of Alberta Hospital
- British Columbia Children's Hospital
- CancerCare Manitoba
- IWK Health Centre
- McMaster Children's Hospital at Hamilton Health Sciences
- Children's Hospital of Eastern Ontario
- Centre Hospitalier Universitaire Sainte-Justine
- Centre Hospitalier Universitaire de Quebec
- San Jorge Children's Hospital
Arms of the Study
Arm 1
Experimental
Treatment (chemotherapy, biological therapy)
Patients receive paclitaxel IV over 3 hours and carboplatin IV over 1 hour on day 1 and ifosfamide IV over 1 hour on days 1-5. Beginning on day 6, patients receive filgrastim (G-CSF) subcutaneously or IV once daily until blood count returns to normal. Treatment repeats every 21 days for 2 courses in the absence of disease progression or unacceptable toxicity.