Adolescents and Young Adults With a “Rare” Cancer: Getting Past Semantics to Optimal Care for Patients With Germ Cell Tumors

Stoneham, Sara; Hale, Juliet; Rodríguez‐Galindo, Carlos; Dang, Ha X.; Olson, Thomas A.; Murray, Matthew J.; Amatruda, James F.; Thornton, Claire M.; Arul, G. Suren; Billmire, Deborah F.; Krailo, Mark; Stark, Dan; Covens, Al; Hurteau, Jean; Stenning, Sally; Nicholson, James C.; Gershenson, David M.; Frazier, A. Lindsay

doi:10.1634/theoncologist.2014-0009erratum

Cited by 4 publications

(5 citation statements)

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“…Wong et al [9] found a male:female ratio of 82:32 for intracranial adolescent MGCTs. In the United States [13,14], the maximum incidence rate of extracranial MGCTs is 11.4 per 100,000 in males, but only one per 100,000 in females, indicating that the number of male patients is higher than that of females, which was consistent with our study.…”

Section: Discussionsupporting

confidence: 91%

Clinical characteristics of malignant germ cell tumors in adolescents: A multicenter 10‐year retrospective study in Beijing

Zhao,

Li,

Sun

et al. 2023

Cancer Innovation

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BackgroundThe aim of this study was to review clinical features of adolescent malignant germ cell tumors (MGCTs) in Beijing and analyze the peculiar characteristics of this age group.MethodsClinical characteristics, pathological presentations, and survival outcomes of 34 patients were analyzed retrospectively.ResultsOf 34 patients, 12 girls and 22 boys, 18 (52.9%) had an extra‐cranial tumor, including one testicular tumor, five ovarian tumors, one sacrococcygeal tumor, and 11 mediastinal tumors. Histologically, we found immature teratomas (n = 6), yolk sac tumors (n = 5), mixed malignant tumors (n = 5), an embryonic carcinoma (n = 1), and seminoma (n = 1). Three‐year event‐free survival (EFS) and overall survival (OS) were 48.8% and 62.9%, respectively. Another 16 (47.1%) patients had an intracranial tumor, including nine in the pineal region, five in the suprasellar region, one in basal ganglia, and one in cerebellopontine. All patients had localized disease and an excellent outcome with 3‐year EFS and OS of 93.7% and 100%, respectively.ConclusionsAdolescent MGCTs are rare with a strong dependence on gender, and the mediastina and pineal region are the most common tumor locations. The prognosis is promising compared with that of other adolescent tumors and MGCTs in other age groups. MGCTs in mediastina have a tendency to companion with other hematological malignancies, and the prognosis is extremely poor in these patients.

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Section: Discussionsupporting

confidence: 91%

Clinical characteristics of malignant germ cell tumors in adolescents: A multicenter 10‐year retrospective study in Beijing

Zhao,

Li,

Sun

et al. 2023

Cancer Innovation

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“…To date, it is not known whether adolescents with GCTs are more effectively treated with pediatric or adult approaches. Compounding this matter is the observation that adolescents with GCTs are underrepresented in clinical trials, frequently being too old to meet the age inclusion criteria of pediatric trials and too young to meet age eligibility for adult studies 20 …”

Section: Introductionmentioning

confidence: 99%

“…The Malignant Germ Cell International Consortium (MaGIC) assembled a large pooled data set of patients with extracranial GCTs treated across multiple clinical trials and collaborative groups, 20,22 and this allowed for a secondary analysis of prospective trial data. For the current study, we derived a relatively homogeneous subgroup of male patients with GCTs across 3 age groups (children, adolescents, and young adults) in order to compare EFS.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of adolescent males with extracranial metastatic germ cell tumors: A report from the Malignant Germ Cell Tumor International Consortium

Shaikh

Stark

Fonseca

et al. 2020

Cancer

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BackgroundAdolescents with extracranial metastatic germ cell tumors (GCTs) are often treated with regimens developed for children, but their clinical characteristics more closely resemble those of young adult patients. This study was designed to determine event‐free survival (EFS) for adolescents with GCTs and compared them with children and young adults.MethodsAn individual patient database of 11 GCT trials was assembled: 8 conducted by pediatric cooperative groups and 3 conducted by an adult group. Male patients aged 0 to 30 years with metastatic, nonseminomatous, malignant GCTs of the testis, retroperitoneum, or mediastinum who were treated with platinum‐based chemotherapy were included. The age groups were categorized as children (0 to <11 years), adolescents (11 to <18 years), and young adults (18 to ≤30 years). The study compared EFS and adjusted for risk group by using Cox proportional hazards analysis.ResultsFrom a total of 2024 individual records, 593 patients met the inclusion criteria: 90 were children, 109 were adolescents, and 394 were young adults. The 5‐year EFS rate was lower for adolescents (72%; 95% confidence interval [CI], 62%‐79%) than children (90%; 95% CI, 81%‐95%; P = .003) or young adults (88%; 95% CI, 84%‐91%; P = .0002). The International Germ Cell Cancer Collaborative Group risk group was associated with EFS in the adolescent age group (P = .0020). After adjustments for risk group, the difference in EFS between adolescents and children remained significant (hazard ratio, 0.30; P = .001).ConclusionsEFS for adolescent patients with metastatic GCTs was similar to that for young adults but significantly worse than for that children. This finding highlights the importance of coordinating initiatives across clinical trial organizations to improve outcomes for adolescents and young adults.LAY SUMMARY Adolescent males with metastatic germ cell tumors (GCTs) are frequently treated with regimens developed for children. In this study, a large data set of male patients with metastatic GCTs across different age groups has been built to understand the outcomes of adolescent patients in comparison with children and young adults. The results suggest that adolescent males with metastatic GCTs have worse results than children and are more similar to young adults with GCTs. Therefore, the treatment of adolescents with GCTs should resemble therapeutic approaches for young adults.

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“…Pediatricians worry about the long‐term treatment sequelae (neuro‐ and nephrotoxicity, lung fibrosis, hypertension, and etoposide‐related secondary leukemia,) and try to avoid chemotherapy. Cisplatin is measurable in the serum for years after exposure, and detectable in every bodily organ at autopsy . The cumulative prevalence of serious or life‐threatening chronic medical conditions by 45 years of age among pediatric cancer survivors is reportedly as high as 80%, suggesting premature aging as a consequence of childhood cancer therapies .…”

Section: Discussionmentioning

confidence: 99%

Malignant ovarian germ cell tumors in pediatric patients: The AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica) study

Terenziani

Bisogno

Boldrini

et al. 2017

Pediatric Blood & Cancer

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Objective: Malignant ovarian germ cell tumors (MOGCT) carry an excellent prognosis, and the treatment aims to achieve results with the least possible treatment-related morbidity. The aim of this study was to assess the outcomes of pediatric patients with MOGCT. 5-year overall survival [OS] 100%), seven relapsed (three patients with Dysg and four patients with Non-Dysg) and were rescued with chemotherapy (plus surgery in three patients). Among the evaluable patients with stages II-IV, 48 (98%) achieved complete remission after chemotherapy ± surgery, one (IT + AFP, stage IV) had progressive disease. In the whole series (median follow-up 80 months), the 5-year OS and EFS were 98.5% (95% CI: 95.6-100%) and 84.5% (95% CI: 76.5-93.5%). Conclusions:We confirm the excellent outcome for MOGCT. Robust data are lacking on surgical staging, surveillance for Non-Dysg with stage I, the management of IT + AFP, and the most appropriate BEP regimen. As pediatric oncologists, we support the role of surveillance after proper surgical staging providing cases are managed by experts at specialized pediatric centers.

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Adolescents and Young Adults With a “Rare” Cancer: Getting Past Semantics to Optimal Care for Patients With Germ Cell Tumors

Cited by 4 publications

References 0 publications

Clinical characteristics of malignant germ cell tumors in adolescents: A multicenter 10‐year retrospective study in Beijing

Clinical characteristics of malignant germ cell tumors in adolescents: A multicenter 10‐year retrospective study in Beijing

Outcomes of adolescent males with extracranial metastatic germ cell tumors: A report from the Malignant Germ Cell Tumor International Consortium

Malignant ovarian germ cell tumors in pediatric patients: The AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica) study

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