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Combination Chemotherapy in Treating Young Patients With Recurrent or Resistant Malignant Germ Cell Tumors

Treatment of Recurrent or Resistant Pediatric Malignant Germ Cell Tumors With Paclitaxel, Ifosfamide and Carboplatin

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00467051
Enrollment
20
Registered
2007-04-27
Start date
2007-11-05
Completion date
2018-06-30
Last updated
2018-08-29

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Childhood Extracranial Germ Cell Tumor, Childhood Extragonadal Malignant Germ Cell Tumor, Childhood Malignant Ovarian Germ Cell Tumor, Childhood Malignant Testicular Germ Cell Tumor, Ovarian Choriocarcinoma, Ovarian Embryonal Carcinoma, Ovarian Yolk Sac Tumor, Recurrent Childhood Malignant Germ Cell Tumor, Recurrent Malignant Testicular Germ Cell Tumor, Recurrent Ovarian Germ Cell Tumor, Testicular Choriocarcinoma, Testicular Embryonal Carcinoma, Testicular Mixed Choriocarcinoma and Embryonal Carcinoma, Testicular Mixed Choriocarcinoma and Yolk Sac Tumor, Testicular Mixed Embryonal Carcinoma and Yolk Sac Tumor, Testicular Yolk Sac Tumor

Brief summary

This phase II trial is studying how well giving combination chemotherapy works in treating young patients with recurrent or resistant malignant germ cell tumors. Drugs used in chemotherapy, such as paclitaxel, ifosfamide, and carboplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) may kill more tumor cells.

Detailed description

PRIMARY OBJECTIVES: I. Determine the response rate in pediatric patients with recurrent or resistant malignant germ cell tumors (GCT) treated with paclitaxel, ifosfamide, and carboplatin. SECONDARY OBJECTIVES: I. Determine the toxicity of this regimen in these patients. II. To Collect tissue for the tumor bank that will aid in the identification of the biological characteristics of recurrent GCT. OUTLINE: This is a multicenter study. 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. After completion of study treatment, patients are followed periodically for up to 5 years.

Interventions

OTHERLaboratory Biomarker Analysis

Optional correlative studies

DRUGPaclitaxel

Given IV

DRUGIfosfamide

Given IV

DRUGCarboplatin

Given IV

BIOLOGICALFilgrastim

Given IV or subcutaneously

Sponsors

National Cancer Institute (NCI)
CollaboratorNIH
Children's Oncology Group
Lead SponsorNETWORK

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
No minimum to 21 Years
Healthy volunteers
No

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

Design outcomes

Primary

MeasureTime frameDescription
Response Rate as Measured by Response Evaluation Criteria in Solid Tumors (RECIST) CriteriaAt baseline (day 1) and after completion of protocol therapy (2 cycles or 42 days)Patients who demonstrate a PR or CR, as defined below, will be considered as responders. RECIST criteria: CR (complete response) = disappearance of all target lesions, PR (partial response) = 30% decrease in the sum of the longest diameter of target lesions, PD (progressive disease) = 20% increase in the sum of the longest diameter of target lesions and SD (stable disease) = small changes that do not meet above criteria.

Secondary

MeasureTime frame
The Number of Patients Who Experience at Least One Grade 3 or Higher CTC Version 4 Toxicity.Two cycles of chemotherapy; expected to be 42 days of treatment.

Countries

Australia, Canada, Puerto Rico, United States

Participant flow

Participants by arm

ArmCount
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. paclitaxel: Given IV dosage 135 mg/m2/dose carboplatin: Given IV dosage in mg/m2 = Target AUC (mg•min/mL) x \[(0.93 x GFR mL/min/m2) + 15\]= 6.5 x \[(0.93 x GFR mL/min/m2) + 15\]. (BSA = body surface area in square meters). GFR is reported in institutions as uncorrected or raw (not normalized to BSA) or corrected. This number needs to be converted to GFR in mL/min/m2. ifosfamide: Given IV dosage 1800 mg/m2/dose filgrastim: Given IV or subcutaneously dosage 1,080mg/m2/day divided to three equal doses of 360mg/m2 laboratory biomarker analysis: Optional correlative studies
20
Total20

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyAdverse Event2

Baseline characteristics

CharacteristicTreatment (Chemotherapy, Biological Therapy)
Age, Categorical
<=18 years
20 Participants
Age, Categorical
>=65 years
0 Participants
Age, Categorical
Between 18 and 65 years
0 Participants
Age, Continuous13.5 years
Ethnicity (NIH/OMB)
Hispanic or Latino
8 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
11 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
1 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
Race (NIH/OMB)
Asian
1 Participants
Race (NIH/OMB)
Black or African American
1 Participants
Race (NIH/OMB)
More than one race
0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
Race (NIH/OMB)
Unknown or Not Reported
4 Participants
Race (NIH/OMB)
White
14 Participants
Region of Enrollment
Australia
1 participants
Region of Enrollment
Canada
3 participants
Region of Enrollment
Puerto Rico
1 participants
Region of Enrollment
United States
15 participants
Sex: Female, Male
Female
8 Participants
Sex: Female, Male
Male
12 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
18 / 20
serious
Total, serious adverse events
0 / 20

Outcome results

Primary

Response Rate as Measured by Response Evaluation Criteria in Solid Tumors (RECIST) Criteria

Patients who demonstrate a PR or CR, as defined below, will be considered as responders. RECIST criteria: CR (complete response) = disappearance of all target lesions, PR (partial response) = 30% decrease in the sum of the longest diameter of target lesions, PD (progressive disease) = 20% increase in the sum of the longest diameter of target lesions and SD (stable disease) = small changes that do not meet above criteria.

Time frame: At baseline (day 1) and after completion of protocol therapy (2 cycles or 42 days)

ArmMeasureGroupValue (NUMBER)
Treatment (Chemotherapy, Biological Therapy)Response Rate as Measured by Response Evaluation Criteria in Solid Tumors (RECIST) CriteriaResponder12 participants
Treatment (Chemotherapy, Biological Therapy)Response Rate as Measured by Response Evaluation Criteria in Solid Tumors (RECIST) CriteriaNon-Responder8 participants
Secondary

The Number of Patients Who Experience at Least One Grade 3 or Higher CTC Version 4 Toxicity.

Time frame: Two cycles of chemotherapy; expected to be 42 days of treatment.

Population: All eligible patients.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Treatment (Chemotherapy, Biological Therapy)The Number of Patients Who Experience at Least One Grade 3 or Higher CTC Version 4 Toxicity.18 Participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026