Lowered Cisplatin Dose and No Bleomycin in the Treatment of Pediatric Germ Cell Tumors: Results of the GCT-99 Protocol From the Brazilian Germ Cell Pediatric Oncology Cooperative Group

Lowered Cisplatin Dose and No Bleomycin in the Treatment of Pediatric Germ Cell Tumors: Results of the GCT-99 Protocol From the Brazilian Germ Cell Pediatric Oncology Cooperative Group

Author Lopes, Luiz Fernando Google Scholar
Pacheco Donato Macedo, Carla Renata Autor UNIFESP Google Scholar
Aguiar, Simone dos Santos Google Scholar
Barreto, Jose Henrique S. Google Scholar
Martins, Gisele Eiras Google Scholar
Sonaglio, Viviane Google Scholar
Milone, Marcelo Google Scholar
Lima, Eduardo Ribeiro Google Scholar
de Assis Almeida, Maria Teresa Google Scholar
Azevedo Allemand Lopes, Paula Maria Google Scholar
Watanabe, Flora Mitie Google Scholar
Mello D'Andrea, Maria Lydia Google Scholar
Pianovski, Mara Albonei Google Scholar
Melaragno, Renato Google Scholar
Rossi Vianna, Sonia Maria Google Scholar
Schultz Moreira, Mauber Eduardo Google Scholar
Bruniera, Paula Google Scholar
de Oliveira, Cleyton Zanardo Google Scholar
Abstract Purpose We describe the results of a risk-adapted, response-based therapeutic approach from the Brazilian GCT-99 study on germ cell tumors. Patients and Methods From May 1999 to October 2009, 579 participants were enrolled in the Brazilian GCT-99 study. Treatment, defined as specific chemotherapy regimen and number of cycles, was allocated by means of risk-group assignment at diagnosis with consideration for stage and primary tumor site. Patients at low risk received no chemotherapy. Patients at intermediate risk (IR) with a good response (GR) received four cycles of platinum and etoposide (PE), for total doses of platinum 420 mg/m(2) and etoposide 2,040 mg/m(2). Patients at IR with a partial response (PR) received three cycles of PE plus three cycles of ifosfamide, vinblastine, and bleomycin. Patients at high risk (HR) with a GR received four cycles of PE and ifosfamide (PEI) at total doses of platinum 420 mg/m2, etoposide 1,200 mg/m(2), and ifosfamide 30 g/m(2). Patients at HR with a PR received six cycles of PEI. Results The risk-group distribution was 213 LR, 138 IR, and 129 HR for 480 evaluable patients. Overall survival (OS) and event -free survival (EFS) rates at 10 years were, respectively, 90% and 88.6% in the IR-GR group (n = 126) and 74.1% and 74.1% in the IR-PR group (n = 12). Ten-year rates for the HR-GR group (n = 86) were an OS of 66.8% and an EFS of 62.5%. The HR -PR group (n = 43) had an OS of 74.8% and an EFS of 73.4%. In univariable and multivariable analysis, increased serum lactate dehydrogenase level and histology for a metastatic immature teratoma were prognostic of a worsened outcome. Conclusion Reduction of therapy to two drugs did not compromise survival outcomes for patients in the IR-GR group, and escalation of therapy with PEI did not significantly improve OS and EFS in patients at HR. 2016 by American Society of Clinical Oncology
xmlui.dri2xhtml.METS-1.0.item-coverage Alexandria
Language English
Date 2016
Published in Journal Of Clinical Oncology. Alexandria, v. 34, n. 6, p. 603-+, 2016.
ISSN 0732-183X (Sherpa/Romeo, impact factor)
Publisher Amer Soc Clinical Oncology
Extent 603-+
Origin http://dx.doi.org/10.1200/JCO.2014.59.1420
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000374332900018
URI https://repositorio.unifesp.br/handle/11600/57965

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