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Active Surveillance, Bleomycin, Etoposide, Carboplatin or Cisplatin in Treating Pediatric and Adult Patients With Germ Cell Tumors
This phase III trial studies how well active surveillance help doctors to monitor subjects with low risk germ cell tumors for recurrence after their tumor is removed. When the germ cell tumor has spread outside of the organ in which it developed, it is considered metastatic. Drugs used in chemotherapy, such as bleomycin, carboplatin, etoposide, and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading.
The trial studies whether carboplatin or cisplatin is the preferred chemotherapy to use in treating metastatic standard risk germ cell tumors.
Study details:
PRIMARY OBJECTIVES:. I. To evaluate whether a strategy of complete surgical resection followed by surveillance can maintain an overall survival rate of at least 95.
7% at two years for pediatric, adolescent and adult patients with stage I (low risk) malignant germ cell tumors, and at least 95% for patients with ovarian pure immature teratoma. II. To compare the event-free survival of a carboplatin versus (vs.
) cisplatin-based regimen in the treatment of pediatric, adolescent and young adult patients with standard risk non-seminomatous germ cell tumors. IIa. To compare the event free survival (EFS) of a carboplatin-based regimen (carboplatin \[C\] etoposide \[E\] bleomycin \[b\]) vs.
a cisplatin-based regimen (cisplatin \[P\]Eb) in children (less than 11 years in age) with standard risk germ cell tumors (GCT). IIb. To compare the EFS of a carboplatin-based regimen (BEC) vs.
a cisplatin-based regimen (BEP) in adolescents and young adults (ages 11 - \< 25 years) with standard risk GCT. SECONDARY OBJECTIVES:. I.
To compare the incidence of ototoxicity in children, adolescents and young adults with standard risk germ cell tumors treated with carboplatin-based chemotherapy as compared to cisplatin-based chemotherapy. II. To refine and validate a novel patient-reported measure of hearing outcomes for children, adolescents and young adults with standard risk germ cell tumors.
EXPLORATORY OBJECTIVES:. I. To prospectively determine the correlation of tumor marker decline (alpha-fetoprotein \[FP\] and beta-human chorionic gonadotropin \[HCG\]) with clinical outcome in low and standard risk germ cell tumor patients.
II. To compare self-reported peripheral neuropathy and other patient-reported outcomes between children, adolescents and young adults with standard risk germ cell tumors treated with carboplatin-based chemotherapy as compared to cisplatin-based chemotherapy. III.
Assess the relationship between hearing loss as measured by audiometry with the effects of tinnitus as assessed on the Adolescent and Young Adult Hearing Screening (AYA-HEARS) instrument. IV. To evaluate the prognostic significance of serum micro ribonucleic acid (miRNA)s in stage I testicular cancer (seminoma and non-seminoma) patients by collecting clinical data and serum specimens for future analysis.
OUTLINE:. Patients with low-risk stage I grade 2, 3 ovarian immature teratoma or stage I non-seminoma malignant germ cell tumors (MGCT)s undergo observation and can transfer to standard risk arm at time of recurrence if eligibility criteria are met. Patients with stage I seminoma testicular MGCT undergo observation, and those with residual/recurrent disease are treated at the discretion of their physician.
Patients undergo computed tomography (CT), magnetic resonance imaging (MRI), and/or chest x-ray as well as blood sample collection throughout the trial to monitor for response and recurrence. Patients may also undergo a tumor biopsy throughout the trial. Patients with standard risk 1 are randomized into 1 of 2 arms.
ARM I (CEb): Patients receive bleomycin intravenously (IV) over 10 minutes and carboplatin IV over 1 hour on day 1. Patients also receive etoposide IV over 1-2 hours on days 1-5. Treatment repeats every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.
Patients undergo CT, MRI, and/or chest x-ray as well as blood sample collection throughout the trial. Patients may also undergo a tumor biopsy throughout the trial. Patients undergo a pulmonary function test on study.
ARM II (PEb): Patients receive bleomycin IV over 10 minutes on day 1. Patients also receive etoposide IV over 1-2 hours and cisplatin IV over 1-3 hours on days 1-5. Treatment repeats every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.
Patients undergo CT, MRI, and/or chest x-ray as well as blood sample collection throughout the trial. Patients may also undergo a tumor biopsy throughout the trial. Patients undergo a pulmonary function test on study.
Patients with standard risk 2 are randomized into 1 of 2 arms. ARM III (BEC): Patients receive bleomycin IV over 10 minutes on days 1, 8, and 15, etoposide IV over 1-2 hours on days 1-5, and carboplatin IV over 1 hour on day 1. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity.
Patients undergo CT, MRI, and/or chest x-ray as well as blood sample collection throughout the trial. Patients may also undergo a tumor biopsy throughout the trial. Patients undergo a pulmonary function test on study.
ARM IV (BEP): Patients receive bleomycin IV over 10 minutes on days 1, 8, and 15, etoposide IV over 1-2 hours on days 1-5, and cisplatin IV over 1-3 hours on days 1-5. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo CT, MRI, and/or chest x-ray as well as blood sample collection throughout the trial.
Patients may also undergo a tumor biopsy throughout the trial. Patients undergo a pulmonary function test on study. After completion of study treatment, patients are followed up every 2 months for 12 months, every 3-6 months to 24 months, every 6 months for years 3-5, and then annually for up to 10 years.
Eligibility criteria
Researchers look for people who fit a certain description, called eligibility criteria. See if you qualify.
Inclusion criteria
Exclusion criteria
Eligibility
Age eligible for study : 0 and older
Healthy volunteers accepted : No
Gender eligible for study: All
Things to know
Study dates
Study start: 2017-05-25
Primary completion: 2027-06-30
Study completion finish: 2027-06-30
Study type
TREATMENT
Phase
PHASE3
Trial ID
NCT03067181
Intervention or treatment
OTHER: Best Practice
PROCEDURE: Biopsy
PROCEDURE: Biospecimen Collection
BIOLOGICAL: Bleomycin Sulfate
DRUG: Carboplatin
DRUG: Cisplatin
PROCEDURE: Computed Tomography
DRUG: Etoposide
PROCEDURE: Magnetic Resonance Imaging
OTHER: Pharmacogenomic Study
PROCEDURE: Pulmonary Function Test
OTHER: Quality-of-Life Assessment
OTHER: Questionnaire Administration
Conditions
- • Childhood Extracranial Germ Cell Tumor
- • Extragonadal Embryonal Carcinoma
- • Germ Cell Tumor
- • Malignant Germ Cell Tumor
- • Malignant Ovarian Teratoma
- • Stage I Ovarian Choriocarcinoma
- • Stage I Ovarian Embryonal Carcinoma AJCC v6 and v7
- • Stage I Ovarian Teratoma AJCC v6 and v7
- • Stage I Ovarian Yolk Sac Tumor AJCC v6 and v7
- • Stage I Testicular Choriocarcinoma AJCC v6 and v7
- • Stage I Testicular Embryonal Carcinoma AJCC v6 and v7
- • Stage I Testicular Seminoma AJCC v6 and v7
- • Stage I Testicular Yolk Sac Tumor AJCC v6 and v7
- • Stage II Ovarian Choriocarcinoma
- • Stage II Ovarian Embryonal Carcinoma AJCC v6 and v7
- • Stage II Ovarian Yolk Sac Tumor AJCC v6 and v7
- • Stage II Testicular Choriocarcinoma AJCC v6 and v7
- • Stage II Testicular Embryonal Carcinoma AJCC v6 and v7
- • Stage II Testicular Yolk Sac Tumor AJCC v6 and v7
- • Stage III Ovarian Choriocarcinoma
- • Stage III Ovarian Embryonal Carcinoma AJCC v6 and v7
- • Stage III Ovarian Yolk Sac Tumor AJCC v6 and v7
- • Stage III Testicular Choriocarcinoma AJCC v6 and v7
- • Stage III Testicular Embryonal Carcinoma AJCC v6 and v7
- • Stage III Testicular Yolk Sac Tumor AJCC v6 and v7
- • Stage IV Ovarian Choriocarcinoma
- • Stage IV Ovarian Embryonal Carcinoma AJCC v6 and v7
- • Stage IV Ovarian Yolk Sac Tumor AJCC v6 and v7
- • Testicular Mixed Choriocarcinoma and Embryonal Carcinoma
- • Testicular Mixed Choriocarcinoma and Teratoma
- • Testicular Mixed Choriocarcinoma and Yolk Sac Tumor
Find a site
Closest Location:
John Hunter Children's Hospital
Research sites nearby
Select from list below to view details:
John Hunter Children's Hospital
Hunter Regional Mail Centre, New South Wales, Australia
Sydney Children's Hospital
Randwick, New South Wales, Australia
The Children's Hospital at Westmead
Westmead, New South Wales, Australia
Queensland Children's Hospital
South Brisbane, Queensland, Australia
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Participant Group/Arm | Intervention/Treatment |
---|---|
EXPERIMENTAL: Arm I (bleomycin, carboplatin, etoposide)
| PROCEDURE: Biopsy
|
EXPERIMENTAL: Arm II (bleomycin, etoposide, cisplatin)
| PROCEDURE: Biopsy
|
EXPERIMENTAL: Arm III (bleomycin, etoposide, carboplatin)
| PROCEDURE: Biopsy
|
EXPERIMENTAL: Arm IV (bleomycin, etoposide, cisplatin)
| PROCEDURE: Biopsy
|
EXPERIMENTAL: Low-Risk (observation)
| OTHER: Best Practice
|
What is the study measuring?
Primary outcome
Primary Outcome Measure | Primary Outcome Description | Primary Outcome Time Frame |
---|---|---|
Overall survival | The time from study entry to the date of death, or date of last contact and ascertained as alive, whichever comes first. | Two years post enrollment |
Event-free survival | The time from study entry to the date of death, date of disease progression or recurrence, date of second malignant neoplasm or date of last contact and ascertained as alive, whichever comes first. | Two years post enrollment |
Secondary outcome
Secondary Outcome Measure | Secondary Outcome Description | Secondary Outcome Time Frame |
---|---|---|
Proportion of participants with hearing loss | The hearing loss is evaluated according to the International Society of Pediatric Oncology criteria. | 8 weeks after the last dose of platin therapy |
Number of participants by understanding score category in the Adolescents and Young Adults-Hearing Screen | Understanding score will be rated on a 5-point Likert scale ranging from 0 = completely incorrect to 4 = completely correct. | Baseline |
Frequently Asked Questions
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