docetaxel in treating patients with recurrent or refractory germ cell cancer

Conditions: Extragonadal Germ Cell Tumor; Ovarian Cancer; Testicular Germ Cell Tumor

Summary: rationale: drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. purpose: phase ii trial to study the effectiveness of docetaxel in treating patients with recurrent or refractory germ cell cancer.

objectives: i. determine whether partial or complete responses can be achieved with docetaxel (txt) in patients with recurrent or refractory disseminated germ cell cancer previously treated with standard-dose chemotherapy. ii. assess the probability of actual response warranting further evaluation of the therapeutic effectiveness of txt in the case that partial or complete tumor responses are achieved in this patient population. iii. characterize further the toxic effects of txt in these patients. outline: patients receive intravenous docetaxel over 1 hour every 3 weeks until disease progression, unacceptable toxicity, or at least 3 courses beyond documentation of complete response. patients may receive concurrent radiotherapy provided not all indicator lesions are included in irradiated field. resection of residual mature teratoma is allowed no sooner than 8 weeks after therapy provided tumor markers are normalized for at least 4 weeks. projected accrual: a total of 14-25 patients will be accrued for this study.

Eligibility criteria:
disease characteristics: histologically confirmed extragonadal and gonadal germ cell tumor seminoma and nonseminoma eligible recurrent or refractory disease despite adequate first-line cisplatin- or carboplatin-based chemotherapy and not amenable to surgery and/or curative radiotherapy relapse after disease-free interval of 1 or more years ineligible measurable or evaluable disease with documented progression within 2 months prior to entry elevated beta human chorionic gonadotropin and alpha-fetoprotein considered evaluable if no other evaluable lesion and provided marker(s): increased since end of last treatment at least 10 times upper limit of normal unless due to tumor lysis rising on 3 successive occasions at least 2-3 days apart if no tumor markers available, cytology or histology should be obtained no inadequately treated cns metastases no pleural or pericardial effusion and/or ascites patient characteristics: age: 18 and over performance status: who 0-2 life expectancy: at least 3 months hematopoietic: absolute granulocyte count at least 2,000/mm3 platelet count at least 100,000/mm3 hepatic: bilirubin no greater than 1.25 times normal ast/alt no greater than 3 times normal alkaline phosphatase no greater than 2.5 times normal renal: creatinine no greater than 1.6 mg/dl creatinine clearance at least 60 ml/min if creatinine borderline (1.1-1.6 mg/dl) other: no active infection no severe malnutrition no pre-existing grade 2 or worse neurotoxicity no pre-existing edema no senility or psychosis no other expected difficulties for follow-up including geographic considerations no other malignancy except: second testicular primary tumor treated basocellular and planocellular skin carcinoma adequately treated carcinoma in situ of the cervix not pregnant or nursing fertile patients must use effective contraception prior concurrent therapy: biologic therapy: not specified chemotherapy: see disease characteristics no prior high dose chemotherapy with or without stem cell transplant at least 3 weeks since chemotherapy and past wbc and platelet nadirs endocrine therapy: not specified radiotherapy: not amenable to curative radiotherapy at least 3 weeks since radiotherapy and recovered surgery: not amenable to surgery

Keywords: recurrent malignant testicular germ cell tumor testicular seminoma recurrent ovarian germ cell tumor extragonadal germ cell tumor