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

• Autor(a) principal: Lopes, Luiz Fernando
• Data de Publicação: 2016
• Outros Autores: Pacheco Donato Macedo, Carla Renata [UNIFESP], Aguiar, Simone dos Santos, Barreto, Jose Henrique S., Martins, Gisele Eiras, Sonaglio, Viviane, Milone, Marcelo, Lima, Eduardo Ribeiro, de Assis Almeida, Maria Teresa, Azevedo Allemand Lopes, Paula Maria, Watanabe, Flora Mitie, Mello D'Andrea, Maria Lydia, Pianovski, Mara Albonei, Melaragno, Renato, Rossi Vianna, Sonia Maria, Schultz Moreira, Mauber Eduardo, Bruniera, Paula, de Oliveira, Cleyton Zanardo
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UNIFESP
• dARK ID: ark:/48912/001300000v3pd
• DOI: 10.1200/JCO.2014.59.1420
• Texto Completo: http://dx.doi.org/10.1200/JCO.2014.59.1420; https://repositorio.unifesp.br/handle/11600/57965

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