Cancer Treatment Today

Malignant germ cell tumors (MGCT) account for 3% to 4% of childhood malignancies (< 15 years of age). Before the advent of multimodal therapy, children with MGCT could expect poor outcomes. Subsequent therapy was based on the larger adult experience with epithelial ovarian cancer because there was a paucity of clinical trials in pediatric patients. Cyclophosphamide-based therapy improved the outcome for patients with localized MGC but for patients with advanced disease, outcome remained poor. The Einhorn regimen dramatically improved the outcome of adults with testicular MGCT and quickly became the standard of care. Concerns about the potential toxicity of cisplatin and bleomycin limited use of this combination in pediatric patients. Most pediatric studies incorporated these agents in combination with cyclophosphamide-based therapy. An excellent 2-year disease-free survival rate was reported for 13 children treated with cisplatin-based therapy.

Boys and adolescents with stages III and IV testicular tumors are treated with surgical resection followed by four courses of standard or high-dose PEB (platinum, etoposide, bleomycin) therapy. The 6-year survival outcome for stage III and IV males younger than 15 years was 100%, with 6-year EFS of 100% and 94%, respectively. The use of high-dose PEB therapy did not improve the outcome for these boys but did cause increased incidence of ototoxicity. Excellent outcomes for boys with testicular germ cell tumors using surgery and observation for stage I tumors and carboplatin, etoposide, and bleomycin (JEB) and other cisplatin-containing chemotherapy regimens for stage II–IV tumors have also been reported by European investigators. Thus, surgery followed by standard-dose platinum-based chemotherapy is the recommended approach for stages II–IV testicular germ cell tumors in children younger than 15 years.

N. Marina, W. B. London, A. L. Frazier, S. Lauer, F. Rescorla, B. Cushing, M. H. Malogolowkin, R. P. Castleberry, R. B. Womer, and T. Olson
Prognostic Factors in Children With Extragonadal Malignant Germ Cell Tumors: A Pediatric Intergroup Study
J. Clin. Oncol., June 1, 2006; 24(16): 2544 – 2548

Paul C. Rogers, Thomas A. Olson, John W. Cullen, Deborah F. Billmire, Neyssa Marina, Frederick Rescorla, Mary M. Davis, Wendy B. London, Stephen J. Lauer, Roger H. Giller, Barbara Cushing, Treatment of Children and Adolescents With Stage II Testicular and Stages I and II Ovarian Malignant Germ Cell Tumors: A Pediatric Intergroup Study—Pediatric Oncology Group 9048 and Children’s Cancer Group 8891 Journal of Clinical Oncology, Vol 22, No 17 (September 1), 2004: pp. 3563-3569

PDQ – http://www.cancer.gov/cancertopics/pdq/treatment/extracranial-germ-cell/HealthProfessional/page8