Autologous Peripheral Blood Stem Cell Transplant for Germ Cell Tumors

This study is currently recruiting participants. (see Contacts and Locations)
Verified March 2014 by Masonic Cancer Center, University of Minnesota
Sponsor:
Information provided by (Responsible Party):
Masonic Cancer Center, University of Minnesota
ClinicalTrials.gov Identifier:
NCT00432094
First received: February 5, 2007
Last updated: March 4, 2014
Last verified: March 2014
  Purpose

RATIONALE: Germ cell tumors (GCT) are highly sensitive to chemotherapy such that even with metastatic disease at diagnosis, many patients can be cured. Patients who fall into the poor risk category or others who relapse can be successfully salvaged with high dose chemotherapy and autologous stem cell transplant (AuSCT). As in other diseases such as myeloma, sequential high dose chemotherapy and AuSCT may improve overall and disease free survival.

PURPOSE: Because prior investigations in GCT suggest that a subset of high risk or relapsed patients may be cured with sequential cycles of high dose chemotherapy and AuSCT, we propose investigating how well non-cross resistant conditioning regimens work in treating patients with relapsed or high risk GCT.


Condition Intervention Phase
Childhood Germ Cell Tumor
Ovarian Cancer
Teratoma
Drug: carboplatin
Drug: etoposide
Drug: ifosfamide
Drug: paclitaxel
Drug: thiotepa
Procedure: autologous hematopoietic stem cell transplantation
Drug: Mesna
Biological: filgrastim
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Autologous Peripheral Blood Stem Cell Transplant for Germ Cell Tumors

Resource links provided by NLM:


Further study details as provided by Masonic Cancer Center, University of Minnesota:

Primary Outcome Measures:
  • Overall survival (OS) [ Time Frame: 1 Year ] [ Designated as safety issue: No ]
    The percentage of people in a study or treatment group who are alive for a certain period of time after they were diagnosed with or treated for a disease, such as cancer. Also called survival rate.


Secondary Outcome Measures:
  • Disease-free survival (DFS) [ Time Frame: 1 Year ] [ Designated as safety issue: No ]
    The length of time after treatment ends that a patient survives without any signs or symptoms of that cancer or any other type of cancer. In a clinical trial, measuring the disease-free survival is one way to see how well a new treatment works.

  • Engraftment of platelets [ Time Frame: Day 42 and Day 100 ] [ Designated as safety issue: No ]
    Platelet engraftment is defined as 20,000/mm^3 (20 x 10^9/L) for 3 consecutive days unsupported by a platelet transfusion.

  • Numbers of Patients Unable to Mobilize Peripheral Blood Stem Cells [ Time Frame: Pre-Transplant ] [ Designated as safety issue: No ]
    Number of patients unable to achieve adequate stem cell mobilization, need to undergo one or tandem transplantation. Stem cell mobilization = A process in which certain drugs are used to cause the movement of stem cells from the bone marrow into the blood. The stem cells can be collected and stored. They may be used later to replace the bone marrow during a stem cell transplant.

  • Engraftment of neutrophils [ Time Frame: Day 42 and Day 100 ] [ Designated as safety issue: No ]
    Neutrophil engraftment is defined as the first day of three consecutive days where the neutrophil count (absolute neutrophil count) is 500 cells/mm3 (0.5 x 109/L) or greater.


Estimated Enrollment: 25
Study Start Date: December 2006
Estimated Study Completion Date: June 2015
Estimated Primary Completion Date: December 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 2 Transplants
Patients with Germ Cell Tumors (GCT) treated with a second tandem autologous stem cell transplant (AuSCT) with non-cross-resistant conditioning regimens.
Drug: carboplatin
Days -6, -5, -4: 500mg/m2^/day intravenously (IV) over 60 minutes
Drug: etoposide
600mg/m^2/day intravenously (IV) over 60 minutes on Days -6 through -3.
Other Names:
  • VP-16
  • Toposar
Drug: thiotepa
150mg/m^2/day intravenously IV over 30 minutes; Days -6, -5 and -4
Other Name: N,N'N'-triethylenethiophosphoramide
Procedure: autologous hematopoietic stem cell transplantation
Peripheral blood stem cell infusion (< 4 x 10^6 CD34+ cells/kg)
Other Name: PBSC
Biological: filgrastim
Beginning Day 5, G-CSF 5 μg/kg/day until absolute neutrophil count (ANC) ≥ 1500/UL for 3 consecutive days.
Other Name: G-CSF
Active Comparator: 1 Transplant
Patients with Germ cell tumors who receive one transplant only.
Drug: ifosfamide
2500 mg/m^2/day continuous infusion intravenously on Days -6, -5 and -4.
Other Names:
  • Mitoxana
  • Ifex
Drug: paclitaxel
225 mg/m^2 intravenous over 3 hours on Day -7.
Other Name: Taxol
Procedure: autologous hematopoietic stem cell transplantation
Peripheral blood stem cell infusion (< 4 x 10^6 CD34+ cells/kg)
Other Name: PBSC
Drug: Mesna
2500 mg/m^2/day continuous infusion intravenously on Days -6, -5 and -4.
Other Name: Uromitexan®
Biological: filgrastim
Beginning Day 5, G-CSF 5 μg/kg/day until absolute neutrophil count (ANC) ≥ 1500/UL for 3 consecutive days.
Other Name: G-CSF

Detailed Description:

OBJECTIVES:

Primary

  • Determine overall survival (OS) of patients with germ cell tumors treated with tandem autologous stem cell transplantation with non-cross-resistant conditioning regimens.

Secondary

  • Determine disease-free survival (DFS) of patients treated with this regimen.
  • Determine the toxicity of tandem transplants
  • Determine the time to engraftment of neutrophils and platelets in patients treated for each transplant
  • Determine the number of patients unable to adequately mobilize sufficient peripheral blood stem cells (PBSC) for tandem transplantation.
  • Identify prognostic factors of patients unlikely to mobilize sufficient PBSC for tandem transplantation.
  • Compare OS and DFS of patients undergoing single vs tandem transplantation.

OUTLINE:

  • Peripheral blood stem cell (PBSC) mobilization with filgrastim (G-CSF): Patients receive G-CSF subcutaneously (SC) beginning on day 1 and continuing until stem cell collection is complete. Patients undergo stem cell collection beginning on day 5 of G-CSF administration and continuing for at least 3 collections until the collection goal is met.
  • Second PBSC mobilization with chemotherapy: Patients not meeting the collection goal receive cyclophosphamide IV over 2 hours on day 1 and G-CSF SC beginning on day 4 and continuing until stem cell collection is complete. Patients meeting the collection goal after PBSC mobilization via G-CSF alone or in combination with chemotherapy will undergo tandem autologous transplantation. If collection goal is not met but the patient has collected > or = 2 x 10^6 CD34 cells/kg, a single autologous transplant will be performed.
  • Single stem cell transplantation (SCT): Patients receive paclitaxel IV over 3 hours on day -7 and ifosfamide IV on days -6 to -4. Patients undergo reinfusion of stem cells on day 0. Patients also receive G-CSF SC or IV beginning on day 1 and continuing until blood counts recover.
  • Tandem SCT: Patients receive treatment as in single SCT. Beginning 30-90 days later, patients receive carboplatin IV over 60 minutes and thiotepa IV over 30 minutes on days -6 to -4 and etoposide IV over 60 minutes on days -6 to -3. Patients undergo reinfusion of stem cells on day 0. Patients also receive G-CSF SC or IV beginning on day 5 and continuing until blood counts recover.

After completion of study treatment, patients are followed at 6, 9, and 12 months and then every 6 months for up to 2 years.

PROJECTED ACCRUAL: A total of 25 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   10 Years to 69 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Diagnosis: Poor Prognosis Non-Seminomas Germ Cell Tumor in ≥ PR1/CR1 or Good or Intermediate Prognosis Seminomas and Non- Seminomas Germ Cell Tumor in ≥ PR1 or ≥ CR2 as defined by the International Germ Cell Cancer Consensus Classification. Patients with increasing tumor markers only (i.e. no imaging evidence of progressive disease) are eligible for transplant.
  • Age: ≥ 10 years and < 70 years of age.
  • Performance status: Karnofsky ≥ 80% (subjects ≥ 16 years of age) Lansky ≥ 80% for subject 10 - 15 years of age
  • Life expectancy: Greater than 8 weeks.
  • Patients must have normal organ function as defined below:

    • Hematologic:

      • Hemoglobin > 8 gm/dL without transfusion and off erythropoietin for 14 days or Aranesp for 21 days
      • White blood cells (WBC) > 2.5 x 10^9/L with an absolute neutrophile count (ANC) > 1.5 x 10^9/L and off G-CSF or GM-CSF for 10 days or Neulasta for 21 days
      • Platelets > 100 x 10^9/L without transfusion and/or a bone marrow cellularity of ≥ 20%
    • Renal: Creatinine ≤ 2.0 mg/dl or creatinine clearance > 50 ml/min.
    • Hepatic: Total bilirubin ≤ 2.0 mg/dl, AST and alkaline phosphatase < 5 x upper limit of normal. No history of severe prior or ongoing chronic liver disease.
    • Cardiac: Patients must be free of symptoms of uncontrolled cardiac disease including unstable angina, decompensated congestive heart failure, or arrhythmia. LVEF ≥45% by MUGA/ECHO.
    • Pulmonary: Patients must have no significant obstructive airways disease (FEV1 must be ≥ 50% of predicted) and must have acceptable diffusion capacity (corrected DLCO > 50% of predicted).
  • Patients with a history of CNS tumor involvement are eligible if they have completed treatment for CNS disease (radiotherapy or surgery or chemotherapy), have recovered from or stabilization of the side effects associated with the therapy and have no evidence of progressive CNS disease at the time of enrollment.

Exclusion Criteria:

  • Patients with serious uncontrolled infections will not be eligible.
  • Male and female patients of reproductive potential must use an approved contraceptive method if appropriate (for example, intrauterine device [IUD], birth control pills, or barrier device) during and for the duration of study participation. The drugs used in this study are pregnancy category D - clear evidence of risk in pregnancy.
  • Pregnant and breast feeding women will not be eligible.

Voluntary written informed consent before performance of any study-related procedure not part of normal medical care, with the understanding that consent may be withdrawn by the subject at any time without prejudice to future medical care.

Additional Eligibility prior to Transplant Two:

  • Total Collection of ≥ 4 x 10^6 CD34 cells/kg prior to transplant one
  • Transplant able to occur between day +30 and day +90 from transplant one
  • Recovery of blood counts as demonstrated by:

    • WBC > 2.5 x 10^9/L with an ANC > 1.5 x 10^9/L and off G-CSF for 3 days
    • Platelets > 50 x 10^9/L without transfusion in the prior 7 days
    • Renal: Creatinine ≤ 2.0 mg/dl or creatinine clearance > 50 ml/min
    • Hepatic: Total bilirubin ≤ 2.0 mg/dl, AST and alkaline phosphatase < 5 x upper limit of normal
  • Infection: Patients with serious uncontrolled infections at the time of planned transplant will be excluded
  • Patients with progressive disease by Response Evaluation Criteria in Solid Tumors (RECIST) criteria by imaging techniques are not eligible to proceed to the second transplant. Tumor marker increase alone is not sufficient to diagnose disease progression.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00432094

Contacts
Contact: Timothy Krepski 612-273-2800 tkrepsk1@fairview.org

Locations
United States, Minnesota
Masonic Cancer Center at University of Minnesota Recruiting
Minneapolis, Minnesota, United States, 55455
Contact: Brian McClune, DO    612-273-2800    bmcclune@umn.edu   
Sponsors and Collaborators
Masonic Cancer Center, University of Minnesota
Investigators
Principal Investigator: Brian McClune, DO Masonic Cancer Center, University of Minnesota
  More Information

Additional Information:
No publications provided

Responsible Party: Masonic Cancer Center, University of Minnesota
ClinicalTrials.gov Identifier: NCT00432094     History of Changes
Other Study ID Numbers: 2006LS032, UMN-MT2005-21, UMN-0608M90586
Study First Received: February 5, 2007
Last Updated: March 4, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by Masonic Cancer Center, University of Minnesota:
childhood extragonadal germ cell tumor
childhood malignant ovarian germ cell tumor
childhood malignant testicular germ cell tumor
stage III malignant testicular germ cell tumor
testicular choriocarcinoma and seminoma
testicular embryonal carcinoma and seminoma
testicular embryonal carcinoma and teratoma with seminoma
testicular embryonal carcinoma and yolk sac tumor with seminoma
testicular yolk sac tumor and teratoma with seminoma
testicular choriocarcinoma and embryonal carcinoma
testicular choriocarcinoma and teratoma
testicular choriocarcinoma and yolk sac tumor
testicular choriocarcinoma
testicular embryonal carcinoma and teratoma
testicular embryonal carcinoma and yolk sac tumor
testicular embryonal carcinoma
testicular yolk sac tumor and teratoma
testicular yolk sac tumor
testicular seminoma
stage IV extragonadal non-seminomatous germ cell tumor
stage IV extragonadal seminoma
stage I extragonadal non-seminomatous germ cell tumor
stage I extragonadal seminoma
stage II extragonadal non-seminomatous germ cell tumor
stage II extragonadal seminoma
stage III extragonadal non-seminomatous germ cell tumor
stage III extragonadal seminoma
stage II ovarian germ cell tumor
stage I malignant testicular germ cell tumor
stage II malignant testicular germ cell tumor

Additional relevant MeSH terms:
Ovarian Neoplasms
Teratoma
Neoplasms, Germ Cell and Embryonal
Endocrine Gland Neoplasms
Neoplasms by Site
Neoplasms
Ovarian Diseases
Adnexal Diseases
Genital Diseases, Female
Genital Neoplasms, Female
Urogenital Neoplasms
Endocrine System Diseases
Gonadal Disorders
Neoplasms by Histologic Type
Etoposide
Paclitaxel
Isophosphamide mustard
Ifosfamide
Thiotepa
Carboplatin
Lenograstim
Antineoplastic Agents, Phytogenic
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Myeloablative Agonists
Immunosuppressive Agents

ClinicalTrials.gov processed this record on July 22, 2014