Combination Chemotherapy in Treating Young Patients With Recurrent or Resistant Malignant Germ Cell Tumors
Condition: 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
MeSH terms: Carcinoma; Neoplasms; Neoplasms, Germ Cell and Embryonal; Germinoma; Ovarian Neoplasms; Testicular Neoplasms; Carcinoma, Embryonal; Endodermal Sinus Tumor; Choriocarcinoma; Recurrence
Intervention: Carboplatin; Filgrastim; Ifosfamide; Laboratory Biomarker Analysis; Paclitaxel
Intervention description: Given IV; Given IV or subcutaneously; Given IV; Optional correlative studies; Given IV
Intervention MeSH terms: Paclitaxel; Carboplatin; Albumin-Bound Paclitaxel; Ifosfamide; Isophosphamide mustard; Lenograstim
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 20.0
Sex: All
Maximum age: 21 Years
Healthy volunteers: No

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.
    

Eligibility criteria:

        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