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Phase 2 Trial of Response-Based Radiation Therapy for Patients With Localized Central Nervous System Germ Cell Tumors (CNS GCT)


Phase 2
3 Years
21 Years
Open (Enrolling)
Both
Childhood Central Nervous System Choriocarcinoma, Childhood Central Nervous System Embryonal Tumor, Childhood Central Nervous System Germ Cell Tumor, Childhood Central Nervous System Germinoma, Childhood Central Nervous System Mixed Germ Cell Tumor, Childhood Central Nervous System Teratoma, Childhood Central Nervous System Yolk Sac Tumor, Childhood Pineal Parenchymal Tumor

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Trial Information

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.


Inclusion Criteria:



- Patients must be newly diagnosed with localized primary CNS non germinomatous germ
cell tumor (NGGCT) (Stratum 1) or localized primary CNS germinoma (Stratum 2); germ
cell tumors (GCTs) located in the suprasellar, pineal, bifocal (pineal +suprasellar),
and ventricles are eligible; tumors present in the above mentioned locations and with
unifocal parenchymal extension are eligible

- Stratum 1( NGGCT): Patients must have one of the following criteria:

- Patients with serum and/or CSF hCGβ > 100 mIU/mL or any elevation of serum
and CSF alpha-fetoprotein (AFP) > 10 ng/mL or greater than the
institutional normal are eligible, irrespective of biopsy results

- Patients with any of the following elements on biopsy/resection are
eligible, irrespective of serum and/or CSF hCGβ and AFP levels: endodermal
sinus tumor (yolk sac),embryonal carcinoma, choriocarcinoma,
malignant/immature teratoma, and mixed GCT with malignant GCT elements

- Stratum 2 (Germinoma): Patients must have one of the following criteria:

- Patients with institutional normal AFP AND hCGβ 5 to ≤ 50 mIU/mL in serum
and/or CSF are eligible; no histologic confirmation required

- Patients with bifocal (pineal + suprasellar) involvement or pineal lesion
with diabetes insipidus AND hCGβ ≤ 100 mIU/mL and institutional normal AFP
in serum and/or CSF are eligible; no histologic confirmation required

- Patients with histologically confirmed germinoma or germinoma mixed with
mature teratoma and hCGβ ≤ 100 mIU/mL and institutional normal AFP in serum
and/or CSF are eligible

- Patients must have negative lumbar CSF cytology; lumbar CSF must be obtained unless
medically contraindicated

- Patients must be enrolled on ALTE07C1 prior to enrollment on ACNS1123

- Patients with mature teratoma with normal tumor markers are not eligible

- Patients with tumors located outside the ventricles (basal ganglia, thalamus) are not
eligible

- Patients with metastatic disease by either MRI evaluation or lumbar CSF cytology are
not eligible

- Peripheral absolute neutrophil count (ANC) ≥ 1,000/μL

- Platelet count ≥ 100,000/μL (transfusion independent)

- Hemoglobin ≥ 8.0 g/dL (may receive red blood cell [RBC] transfusions)

- Creatinine clearance or radioisotope GFR ≥ 70 mL/min/1.73 m² OR serum creatinine
based on age/gender as follows:

- 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)

- 1.5 mg/dL (male) and 1.4 mg/dL (female) (13 to < 16 years of age)

- 1.7 mg/dL (male) and 1.4 mg/dL (female) (≥ 16 years of age)

- Total bilirubin ≤ 1.5 times upper limit of normal (ULN)

- Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) or
serum glutamic pyruvate transaminase(SGPT) (alanine aminotransferase [ALT]) < 2.5
times ULN

- Patients with seizure disorder may be enrolled if well controlled

- Patients must not be in status, coma, or assisted ventilation prior to study
enrollment

- Female patients who are pregnant are ineligible

- Lactating females are not eligible unless they have agreed not to breastfeed their
infants

- Female patients of childbearing potential are not eligible unless a negative
pregnancy test result has been obtained

- Sexually active patients of reproductive potential are not eligible unless they have
agreed to use an effective contraceptive method for the duration of their study
participation

- Patients who had more than 1 prior surgery/biopsy are eligible

- Patients must not have received any prior tumor-directed therapy other than surgical
intervention and corticosteroids

Type of Study:

Interventional

Study Design:

Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

3-year PFS rate with NGGCT

Outcome Description:

Kaplan-Meier estimates will be provided.

Outcome Time Frame:

3 years

Safety Issue:

No

Principal Investigator

Ute Bartels

Investigator Role:

Principal Investigator

Investigator Affiliation:

Children's Oncology Group

Authority:

United States: Food and Drug Administration

Study ID:

ACNS1123

NCT ID:

NCT01602666

Start Date:

May 2012

Completion Date:

Related Keywords:

  • Childhood Central Nervous System Choriocarcinoma
  • Childhood Central Nervous System Embryonal Tumor
  • Childhood Central Nervous System Germ Cell Tumor
  • Childhood Central Nervous System Germinoma
  • Childhood Central Nervous System Mixed Germ Cell Tumor
  • Childhood Central Nervous System Teratoma
  • Childhood Central Nervous System Yolk Sac Tumor
  • Childhood Pineal Parenchymal Tumor
  • Choriocarcinoma
  • Endodermal Sinus Tumor
  • Carcinoma, Embryonal
  • Neoplasms, Germ Cell and Embryonal
  • Neurologic Manifestations
  • Pinealoma
  • Teratoma
  • Germinoma

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