Phase 2 Trial of Response-Based Radiation Therapy for Patients With Localized Central Nervous System Germ Cell Tumors (CNS GCT)
PRIMARY OBJECTIVES:
I. To determine, as measured by the 3-year progression-free survival (PFS) rate and patterns
of failure, whether dose and volume of irradiation can be safely reduced to 30.6 Gy whole
ventricular-field irradiation (WVI) plus 23.4 Gy primary site boost instead of 36 Gy
craniospinal irradiation (CSI) plus primary site boost in the subgroup of children and young
adults with localized nongerminomatous germ cell tumor (NGGCT) who have a magnetic resonance
imaging (MRI) and tumor marker criteria (CSF and serum) for confirmed complete response (CR)
or partial response (PR) to induction chemotherapy and negative serum and cerebrospinal
fluid (CSF) tumor markers OR in patients who have less than a PR after induction
chemotherapy with negative tumor markers who undergo a second-look surgery and are found to
have only mature teratoma, residual scar or fibrosis, and fit the definition of CR/PR after
second-look surgery.
II. To determine, as measured by the 3-year PFS rate and patterns of failure, whether
simplified chemotherapy followed by dose-reduced radiation therapy is effective for treating
children and young adults with localized primary central nervous system (CNS) germinoma who
present with serum and/or CSF human chorionic gonadotropin-beta (hCGβ) =< 50 mIU/mL.
III. To prospectively evaluate and longitudinally model the cognitive, social, and
behavioral functioning of children and young adults who are treated with reduced radiation
dose and volume of irradiation in Stratum 1 (NGGCT) and with dose-reduced radiation therapy
in Stratum 2 (Germinoma) using the ALTE07C1 protocol (This objective will be assessed
independently for the two strata).
SECONDARY OBJECTIVES:
To estimate the PFS and overall survival (OS) distributions of patients with NGGCT treated
with 30.6 Gy WVI and involved-field radiation therapy (IFR) focal boost to 54 Gy. II. To
estimate the PFS and OS distributions of localized-germinoma patients who present with serum
and/or CSF hCGβ ≤ 50 mIU/mL vs serum and/or CSF hCGβ > 50 mIU/mL and =< 100 mIU/mL.
OUTLINE: This is a multicenter study. Patients are stratified according to localized primary
disease (nongerminomatous germ cell tumor [NGGCT] vs germinoma).
Stratum 1 (NGGCT): Patients receive induction therapy comprising carboplatin IV over 15-60
minutes on day 1 and etoposide IV over 1-2 hours on days 1-3 of courses 1, 3, and 5.
Patients also receive ifosfamide IV over 1 hour and etoposide over 1-2 hours on days 1-5
of courses 2, 4, and 6. Treatment repeats every 21 days for 6 courses in the absence of
disease progression or unacceptable toxicity. Patients with responsive disease (complete
[CR] or partial response [PR]) to induction chemotherapy undergo radiotherapy once daily
(QD) 5 days a week for 6 weeks. Patients with PR, stable disease (SD), or progressive
disease (PD) and normalization of tumor levels undergo second-look surgery. Patients who
achieve CR or PR after second-look surgery undergo radiotherapy.
Stratum 2 (Germinoma): Patients receive induction therapy comprising carboplatin IV over
15-60 minutes on day 1 and etoposide IV over 1-2 hours on days 1-3. Treatment repeats every
21 days for 4 courses in the absence of disease progression or unacceptable toxicity.
Patients with CR or continued CR undergo radiotherapy QD 5 days a week for approximately
4 weeks. Patients with PR, SD, or PD with normal tumor markers may undergo second-look
surgery. Patients found to have mature teratoma or non-viable tumor during surgery undergo
radiotherapy. Patients with PR or SD with residual disease (=< 1.5 cm) and suprasellar (>
0.5 cm) or pineal (> 1 cm) involvement and normal tumor markers undergo radiotherapy after
chemotherapy without second-look surgery.
After completion of study treatment, patients are followed up every 3 months for 1 year,
every 4 months for 2 years, and then annually for up to 3 years.
Interventional
Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
3-year PFS rate with NGGCT
Kaplan-Meier estimates will be provided.
3 years
No
Ute Bartels
Principal Investigator
Children's Oncology Group
United States: Food and Drug Administration
ACNS1123
NCT01602666
May 2012
Name | Location |
---|---|
Baylor College of Medicine | Houston, Texas 77030 |
Johns Hopkins University | Baltimore, Maryland 21205 |
Memorial Sloan Kettering Cancer Center | New York, New York 10021 |
Mayo Clinic | Rochester, Minnesota 55905 |
Children's Hospital of Philadelphia | Philadelphia, Pennsylvania 19104 |
University of Mississippi Medical Center | Jackson, Mississippi 39216-4505 |
Washington University School of Medicine | Saint Louis, Missouri 63110 |
Midwest Children's Cancer Center | Milwaukee, Wisconsin 53226 |
Vanderbilt-Ingram Cancer Center | Nashville, Tennessee 37232-6838 |
Loyola University Medical Center | Maywood, Illinois 60153 |
Morristown Memorial Hospital | Morristown, New Jersey 07962-1956 |
Newark Beth Israel Medical Center | Newark, New Jersey 07112 |
New York Medical College | Valhalla, New York 10595 |
Dana-Farber Cancer Institute | Boston, Massachusetts 02115 |
Children's Hospital Los Angeles | Los Angeles, California 90027-0700 |
Children's National Medical Center | Washington, District of Columbia 20010-2970 |
All Children's Hospital | St. Petersburg, Florida 33701 |
Saint Jude Midwest Affiliate | Peoria, Illinois 61637 |
Carolinas Medical Center | Charlotte, North Carolina 28232-2861 |
University of Oklahoma Health Sciences Center | Oklahoma City, Oklahoma 73104 |
St. Jude Children's Research Hospital | Memphis, Tennessee 38105-2794 |
Driscoll Children's Hospital | Corpus Christi, Texas 78466 |
Kosair Children's Hospital | Louisville, Kentucky 40202-3830 |
Children's Hospital Medical Center of Akron | Akron, Ohio 44308 |
Overlook Hospital | Summit, New Jersey 07902-0220 |
Cincinnati Children's Hospital Medical Center | Cincinnati, Ohio 45229-3039 |
Primary Children's Medical Center | Salt Lake City, Utah 84113-1100 |
Montefiore Medical Center | Bronx, New York 10467-2490 |
Children's Hospitals and Clinics of Minnesota - Minneapolis | Minneapolis, Minnesota 55404 |
University of New Mexico Cancer Center | Albuquerque, New Mexico 87131-5636 |
Nationwide Children's Hospital | Columbus, Ohio 43205-2696 |
Children's Hospital of Pittsburgh of UPMC | Pittsburgh, Pennsylvania 15213 |
Children's Hospital and Research Center at Oakland | Oakland, California 94609-1809 |
Presbyterian Hospital | Charlotte, North Carolina 28233-3549 |
Lee Memorial Health System | Fort Myers, Florida 33902 |
University of Alabama at Birmingham | Birmingham, Alabama 35294-3300 |
Children's Hospital of Alabama | Birmingham, Alabama 35233 |
Connecticut Children's Medical Center | Hartford, Connecticut 06106 |
University of North Carolina | Chapel Hill, North Carolina 27599 |
Duke University Medical Center | Durham, North Carolina 27710 |
University of Florida | Gainesville, Florida 32610-0277 |
Helen DeVos Children's Hospital at Spectrum Health | Grand Rapids, Michigan 49503 |
Yale University | New Haven, Connecticut 06520 |
Wayne State University | Detroit, Michigan 48202 |
Legacy Emanuel Children's Hospital | Portland, Oregon 97227 |
BI-LO Charities Children's Cancer Center | Greenville, South Carolina 29605 |
University of Texas Southwestern Medical Center | Dallas, Texas |
University of Kentucky | Lexington, Kentucky 40536-0098 |
Oregon Health and Science University | Portland, Oregon 97201 |
Florida Hospital | Orlando, Florida 32803 |
Seattle Children's Hospital | Seattle, Washington 98105 |
Childrens Memorial Hospital | Chicago, Illinois 60614 |
M D Anderson Cancer Center- Orlando | Orlando, Florida 32806 |
University of Hawaii | Honolulu, Hawaii 96813 |
Saint Vincent Hospital and Health Services | Indianapolis, Indiana 46260 |
Saint John's Mercy Medical Center | Saint Louis, Missouri 63141 |
Nevada Cancer Research Foundation CCOP | Las Vegas, Nevada 89106 |
Saint Barnabas Medical Center | Livingston, New Jersey 07039 |
New York University Langone Medical Center | New York, New York 10016 |
State University of New York Upstate Medical University | Syracuse, New York 13210 |
Saint Vincent Hospital | Green Bay, Wisconsin 54301 |
University of Illinois | Chicago, Illinois 60612 |
Cook Children's Medical Center | Fort Worth, Texas 76104 |
The Children's Medical Center of Dayton | Dayton, Ohio 45404 |
Riley Hospital for Children | Indianapolis, Indiana 46202 |
Miller Children's Hospital | Long Beach, California 90806 |
Childrens Hospital of Orange County | Orange, California 92868-3874 |
Children's Healthcare of Atlanta - Egleston | Atlanta, Georgia 30322 |
The Childrens Mercy Hospital | Kansas City, Missouri 64108 |
Rainbow Babies and Childrens Hospital | Cleveland, Ohio 44106 |
Penn State Hershey Children's Hospital | Hershey, Pennsylvania 17033 |
Palmetto Health Richland | Columbia, South Carolina 29203 |
East Tennessee Childrens Hospital | Knoxville, Tennessee 37916 |
Lucile Packard Children's Hospital Stanford University | Palo Alto, California 94304 |
University of California San Francisco Medical Center-Parnassus | San Francisco, California 94143 |
Raymond Blank Children's Hospital | Des Moines, Iowa 50309 |
Children's Hospital-Main Campus | New Orleans, Louisiana 70118 |
Greenville Cancer Treatment Center | Greenville, South Carolina 29605 |
Sanford USD Medical Center - Sioux Falls | Sioux Falls, South Dakota 57117-5134 |