Gemcitabine, paclitaxel, and oxaliplatin (GEMPOX) in the treatment of relapsed/refractory intracranial nongerminomatous germ cell tumors

Perez‐Somarriba, Marta; Moreno-Tejero, Maria Luisa; Rozas, Maria Isabel; Peláez, Irene; Madero, Luís; Lassaletta, Álvaro

doi:10.1002/pbc.28089

Cited by 7 publications

(4 citation statements)

References 15 publications

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“…Although achieving a partial response (PR) after chemotherapy with an inoperable scar (negative tumor markers), this patient experienced disease progression locally with positive tumor markers, one month after CSI radiotherapy. Despite receiving additional cancer-directed therapies, he progressed after two cycles of Ifosfamide, carboplatin and etoposide and then two cycles of GEMPOX ( 6 ) and passed away 20 months after the initial diagnosis.…”

Section: Resultsmentioning

confidence: 99%

Intracranial non-germinomatous germ cell tumors in children and adolescents: how can the experience from an uppermiddle-income country contribute to the worldwide effort to improve outcomes?

Cappellano,

Dassi,

Mançano

et al. 2024

Front. Oncol.

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BackgroundNon-germinomatous germ cell tumors (NGGCT) accounts for one third of intracranial GCT. While the germinoma group have an excellent overall survival, the standard of practice for children with NGGCT is still under evaluation.AimsDescribe the results of the of the Brazilian consortium protocol.MethodsSince 2013, 15 patients with a diagnosis of NGGCT by histopathology and/or serum/cerebrospinal fluid (CSF) tumor markers, βHCG >200mlU/ml and/or positive alpha-fetoprotein were treated with neoadjuvant chemotherapy with carboplatin, cyclophosphamide and etoposide followed by ventricular radiotherapy (RTV) of 18Gy with boost (32Gy) to the primary site. Metastatic patients underwent craniospinal irradiation (CSI) and “slow responders” to the four initial cycles of CT, to autologous stem cell transplantation (ASCT) followed by CSI.ResultsMean age, 13.1 years. Thirteen males. Primary sites: pineal (n=12), suprasellar (n=2) and bifocal (n=1). Four patients were metastatic at diagnosis. Eight patients had CSF and/or serum alpha-fetoprotein levels > 1,000ng/ml. Tumor responses after chemotherapy demonstrated complete in six cases and partial in seven, with “second-look” surgery being performed in five cases, and two patients presenting viable lesions being referred to ASCT. The main toxicity observed was hematological grades 3/4. Two patients with metastatic disease, one with Down Syndrome and AFP > 1,000ng/ml and the other with choriocarcinoma and pulmonary metastases, developed progressive disease resulting in death, as well as two other patients without evidence of disease, due to endocrinological disorders. Event-free and overall survival at 2 and 5 years were 80% and 72.7%, respectively, with a mean follow-up of 48 months (range, 7-107).ConclusionsDespite the small number of patients, in our series, treatment with six cycles of chemotherapy and RTV with focal boost for localized disease (n=11) and ACST for identified slow responders (n=2) seem to be effective strategies contributing to the overall effort to improve outcomes of this group of patients.

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Section: Resultsmentioning

confidence: 99%

Intracranial non-germinomatous germ cell tumors in children and adolescents: how can the experience from an uppermiddle-income country contribute to the worldwide effort to improve outcomes?

Cappellano,

Dassi,

Mançano

et al. 2024

Front. Oncol.

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“…Nine of the retrieved articles met all inclusion criteria (Figure 1). 3,[7][8][9][10][11][12][13][14] All included studies were retrospective in nature, except for four studies, which were prospective nonrandomized trials (Table 1). [7][8][9] We identified a total of 120 potentially eligible patients.…”

Section: Resultsmentioning

confidence: 99%

Prognostic factors for patients with relapsed central nervous system nongerminomatous germ cell tumors

Abu-Arja

Osorio

Lassaletta

et al. 2021

Pediatric Blood & Cancer

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We aimed toidentify prognostic factors that may help better understand the behavior of relapsed central nervous system nongerminomatous germ cell tumors. We identified nine studies, including 101 patients; 33 patients (33%) were alive 12 months post-initial relapse. Sixty percent of patients with serum/cerebrospinal fluid (CSF) alpha-fetoprotein (AFP) level ≤25 ng/mL at initial diagnosis were survivors compared with 28% among patients with serum/CSF AFP level >25 ng/mL (P = 0.01). Seventy-one percent of patients who achieved complete response/ continued complete response (CR/CCR) by the end of therapy at relapse were survivors compared with 7% among patients who had less than CR/CCR (P < 0.0001).Forty-eight percent of patients who received marrow-ablative chemotherapy followed by autologous hematopoietic cell rescue (HDCx/AuHCR) following relapse were survivors compared with 12% among patients who did not receive HDCx/AuHCR (P = 0.0001). Local relapse site, gross total surgical resection, and radiotherapy at relapse were not associated with improved outcomes.

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“…Another study demonstrated the effectiveness of paclitaxel treatment on children affected by Kaposi sarcoma [ 43 ]. Perez-Somarriba and colleagues observed a strong response with normalization of tumor markers in three patients showing relapsed intracranial NGGCT, after treatment with gemcitabine, paclitaxel, and oxaliplatin [ 44 ]. However, although taxanes have demonstrated high efficacy in adults affected by solid tumors and in pediatric solid tumor in vitro models, their use in children has been restricted by dose-limiting toxicity especially due to the solvent formulation of these drugs [ 45 , 46 ], so these drugs are not yet introduced in clinical practice for pediatric patients.…”

Section: Chemotherapy-induced Cardiotoxicity In Childrenmentioning

confidence: 99%

Circulating Biomarkers for Monitoring Chemotherapy-Induced Cardiotoxicity in Children

Meo,

Savarese,

Munno

et al. 2023

Pharmaceutics

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Most commonly diagnosed cancer pathologies in the pediatric population comprise leukemias and cancers of the nervous system. The percentage of cancer survivors increased from approximatively 50% to 80% thanks to improvements in medical treatments and the introduction of new chemotherapies. However, as a consequence, heart disease has become the main cause of death in the children due to the cardiotoxicity induced by chemotherapy treatments. The use of different cardiovascular biomarkers, complementing data obtained from electrocardiogram, echocardiography cardiac imaging, and evaluation of clinical symptoms, is considered a routine in clinical diagnosis, prognosis, risk stratification, and differential diagnosis. Cardiac troponin and natriuretic peptides are the best-validated biomarkers broadly accepted in clinical practice for the diagnosis of acute coronary syndrome and heart failure, although many other biomarkers are used and several potential markers are currently under study and possibly will play a more prominent role in the future. Several studies have shown how the measurement of cardiac troponin (cTn) can be used for the early detection of heart damage in oncological patients treated with potentially cardiotoxic chemotherapeutic drugs. The advent of high sensitive methods (hs-cTnI or hs-cTnT) further improved the effectiveness of risk stratification and monitoring during treatment cycles.

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Gemcitabine, paclitaxel, and oxaliplatin (GEMPOX) in the treatment of relapsed/refractory intracranial nongerminomatous germ cell tumors

Cited by 7 publications

References 15 publications

Intracranial non-germinomatous germ cell tumors in children and adolescents: how can the experience from an uppermiddle-income country contribute to the worldwide effort to improve outcomes?

Intracranial non-germinomatous germ cell tumors in children and adolescents: how can the experience from an uppermiddle-income country contribute to the worldwide effort to improve outcomes?

Prognostic factors for patients with relapsed central nervous system nongerminomatous germ cell tumors

Circulating Biomarkers for Monitoring Chemotherapy-Induced Cardiotoxicity in Children

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