High-Dose Chemotherapy and Stem Cell Transplant in Treating Patients With Metastatic Germ Cell Tumors That Have Not Responded to First-Line Therapy

This is an interventional treatment trial for Brain and Central Nervous System Tumors focused on measuring recurrent extragonadal germ cell tumor, recurrent extragonadal non-seminomatous germ cell tumor, recurrent malignant testicular germ cell tumor, stage IV extragonadal non-seminomatous germ cell tumor, stage III malignant testicular germ cell tumor, recurrent extragonadal seminoma, stage IV extragonadal seminoma, testicular mature teratoma, adult central nervous system germ cell tumor, testicular immature teratoma Read More

DISEASE CHARACTERISTICS:

• Histologically confirmed germ cell tumor (GCT) based on pathologic review at INT Milan

  • Metastatic disease
  • Relapsed or refractory disease
• Prior chemotherapy treatment for GCT without a pathologic diagnosis due to unequivocal clinical evidence of GCT and an urgent need to start therapy (elevated alpha-fetoprotein [AFP] or human chorionic gonadotropin [HCG] with pattern of metastases consistent with GCT and high tumor burden) allowed

• Unequivocal progression of measurable disease, consisting of abnormalities on 2-dimensional imaging or raised tumor markers, following 1 line of cisplatin-based chemotherapy as documented by either of the following:

  • Tumor biopsy of new, growing, or unresectable lesions demonstrating viable non-teratomatous GCT (enrollment on this study for adjuvant treatment after resection of viable GCT not allowed)
  • Increasing or abnormally elevated serum tumor markers (HCG or AFP) (increasing lactate dehydrogenase [LDH] alone does not constitute progressive disease)
• Received ≥ 3 and ≤ 6, cisplatin-based chemotherapy courses as part of first-line (initial) chemotherapy and ≤ 6 cisplatin-based chemotherapy courses

• Brain metastases allowed

  • May be treated with radiotherapy and/or surgery concurrently with cisplatin, ifosfamide, and etoposide regimen

    • Radiotherapy should not be given concurrently with mobilization phase/leukapheresis and high-dose carboplatin and etoposide

PATIENT CHARACTERISTICS:

• WBC ≥ 2,000/µL
• ANC ≥ 1,500/µL
• Platelet count ≥ 100,000/µL
• Creatinine clearance ≥ 50 cc/min (unless renal dysfunction is due to tumor obstructing the ureters, in which case eligibility will be determined by the principal investigator)
• AST/ALT < 2 times upper limit of normal (ULN) (< 5 times ULN if due to hepatic metastases)
• Total bilirubin < 1.5 times ULN
• Ejection fraction ≥ 50% by echocardiogram

• Negative serology for the following infectious diseases:

  • HIV type 1 and 2
  • Hepatitis B surface antigen (active carriers)
  • Hepatitis C
  • Cytomegalovirus (serum Ag p65 ± PCR confirmation at principal investigator discretion)

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• Recovered from prior surgery
• At least 3 weeks since prior chemotherapy
• No prior high-dose chemotherapy with peripheral blood stem cell rescue
• No more than 1 prior chemotherapy regimen for metastatic disease