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
Conditions
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
Optional correlative studies
Given IV
Given IV
Given IV
Given IV or subcutaneously
Sponsors
Study design
Eligibility
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
| Measure | Time frame | Description |
|---|---|---|
| Response Rate as Measured by Response Evaluation Criteria in Solid Tumors (RECIST) Criteria | At 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
| Measure | Time 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
| Arm | Count |
|---|---|
| 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 |
| Total | 20 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 2 |
Baseline characteristics
| Characteristic | Treatment (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, Continuous | 13.5 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 type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 18 / 20 |
| serious Total, serious adverse events | 0 / 20 |
Outcome results
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)
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Treatment (Chemotherapy, Biological Therapy) | Response Rate as Measured by Response Evaluation Criteria in Solid Tumors (RECIST) Criteria | Responder | 12 participants |
| Treatment (Chemotherapy, Biological Therapy) | Response Rate as Measured by Response Evaluation Criteria in Solid Tumors (RECIST) Criteria | Non-Responder | 8 participants |
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.
| Arm | Measure | Value (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 |