Malignant testicular germ cell tumors in children and adolescents: The AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica) protocol

Abstract

Objectives: We report the results of an Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) study on the treatment of testicular germ cell tumors (TGCT) with a pediatric PEB (pPEB) regimen (cisplatin 25 mg/m 2 daily on days 1-4; etoposide 100 mg/m 2 daily on days 1-4; bleomycin 15 mg/m 2 on day 2, once per cycle).Methods and materials: Male patients under 18 years old with malignant TGCT were enrolled for a second national prospective protocol. All patients underwent orchiectomy at diagnosis. Those with Stage I received no chemotherapy; those with Stage IIÀIII disease received three cycles of pPEB; and those with Stage IV received four cycles. After chemotherapy, resection of radiologically-evident residual disease was recommended. The main study end-points were overall survival and relapse-free survival.Results: Ninety-nine boys from 0.5 to 17.8 years old (median 15.4 years) were evaluable, and staged as follows: 58 Stage I (59%), 7 Stage II (7%), 14 Stage III (14%), and 20 Stage IV (20%). With a median follow-up of 59 months (range 4-165 months), 5-year relapse-free survival (95% CI) was 73% (65%-83%) for the whole sample, 65% (53%-79%) for Stage I patients, and 86% (75%-98%) for Stage II-IV patients. Five-year overall survival (95% CI) was 99% (97%-100%).Conclusions: We confirmed a good prognosis for malignant TGCT in children and adolescents. Reducing the number of chemotherapy cycles for Stage II-III disease does not seem to negatively affect survival outcomes.

Salvage treatment for children with relapsed/refractory germ cell tumors: The Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) experience

“…13 The staging system used in this protocol for malignant tumors was as reported elsewhere. [7][8][9] A centralized pathology review was possible, but not mandatory.…”

“…However, 15% to 20% of these patients still die of their disease. [1][2][3][4][5][6][7][8][9] Efforts to improve prognosis in this subgroup of patients have been made over the years, typically focusing on new chemotherapy regimens and the reduction of therapy side effects. Nonetheless, data and experience regarding secondline treatment for relapsed/refractory GCT in the pediatric setting are sparse, especially with regard to long-term outcome.…”

Malignant sacrococcygeal germ cell tumors in childhood: The Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) experience

“…Subsequent treatments depended on the disease stage: patients with stage I disease and with tumor markers returning to normal level underwent surveillance alone. The others were treated with a pediatric cisplatinum‐etoposide‐bleomycin (pPEB) regimen, consisting of cisplatin 25 mg/m 2 daily on days 1‐4, etoposide 100 mg/m 2 daily on days 1‐4, and bleomycin 15 mg/m 2 on day 2, once per cycle 9 …”

“…CT or MRI scans of the primary site, chest CT scans, and bone scans were repeated after the fourth course, at the suspension of treatment, according to the diagnosis. Response criteria were as reported elsewhere 9 . The normalization of serum markers and the disappearance of tumor lesions on CT or MRI were classified as a complete remission (CR).…”

Apoptotic mechanism activated by blue light and cisplatinum in cutaneous squamous cell carcinoma cells

“…Cisplatinum [cis-diammine-dichloroplatinum (II)] is a potent chemotherapeutic agent widely used in the treatment of skin cancer ( 14 - 16 ), among a wide variety of tumor types, including testicular ( 17 , 18 ), ovarian ( 19 , 20 ), cervical ( 21 - 24 ), head and neck ( 25 - 27 ) and lung ( 28 , 29 ) cancer. It has been observed that cisplatinum induces DNA damage and blocks cell cycle progression at the specific G 2 /M checkpoint ( 30 ), leading to the induction of apoptosis of proliferating cells ( 31 ).…”