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Gynecol Oncol. 2018 Aug;150(2):253-260. doi: 10.1016/j.ygyno.2018.05.025. Epub 2018 Jun 5.

Is carboplatin-based chemotherapy as effective as cisplatin-based chemotherapy in the treatment of advanced-stage dysgerminoma in children, adolescents and young adults?

Author information

1
Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH, USA. Electronic address: rshah@chla.usc.edu.
2
Children's Oncology Group, USA.
3
Children's Oncology Group, USA; University of Southern California, CA, USA.
4
University of Texas Southwestern Medical Center, Children's Medical Center, TX, USA.
5
Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK.
6
Riley Hospital for Children, IN, USA.
7
NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY, USA.
8
University of Toronto, Toronto, Canada.
9
The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
10
Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals Trust, Newcastle Upon Tyne, UK.
11
North Shore University Health System, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
12
Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
13
Aflac Cancer Center, Children's Healthcare of Atlanta, Emory University, GA, USA.
14
Yale University School of Medicine, New Haven, CT, USA.
15
St. Jude Children's Research Hospital, Memphis, TN, USA.
16
The Hospital for Sick Children, University of Toronto, Toronto, Canada.
17
Leeds Institute of Cancer Studies and Pathology, Leeds Institute of Oncology and St. James's University Hospital, Leeds, UK.
18
Dana-Farber/Boston Children's Cancer and Blood Disorders Center, MA, USA.
19
Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, UK.

Abstract

OBJECTIVE:

Dysgerminoma is the most common malignant ovarian germ cell tumor (GCT) with peak incidence during adolescence and young adulthood. Current standard of care for patients with disease that has spread outside of the ovary (advanced-stage) utilizes platin-based chemotherapy regimens. The study objective was to compare clinical outcomes between platin-based (carboplatin versus cisplatin) strategies across all age groups (children < 11 years (y), adolescents = 11-25 y and young adult women > 25 y) for advanced-stage dysgerminoma.

METHODS:

The Malignant Germ Cell Tumor International Consortium (MaGIC) pooled data from six GCT trials (3 = pediatric, 3 = adult) conducted internationally by pediatric and gynecologic oncology clinical trial organizations (CTOs) between 1983 and 2009. Newly diagnosed patients, with advanced-stage (FIGO IC-IV) dysgerminoma, who received either carboplatin- or cisplatin-based chemotherapy were eligible for analysis.

RESULTS:

126 eligible patients were identified; 56 patients (38 = pediatric, 18 = adult) received carboplatin-based and 70 patients (50 = pediatric, 20 = adult) received cisplatin-based chemotherapy. Mean age was 20 y (range = 6-46 y). The median follow-up was 10.3 y (range = 0.17-21.7 y). The five-year event-free survival (EFS5) and overall survival (OS5) was 0.94 (95%CI, 0.88-0.97) and 0.96 (95%CI, 0.91-0.99) respectively. Survival outcomes were comparable between carboplatin-(EFS5 = 0.96 (95%CI, 0.85-0.99), OS5 = 0.96 (95%CI, 0.85-0.99)) and cisplatin-(EFS5 = 0.93 (95%CI, 0.83-0.97), OS5 = 0.96 (95%CI, 0.87-0.99)) based regimens. Across three age groups, comparison of the EFS5 (<11 y = 0.1, 11-25 y = 0.91 (95%CI, 0.82-0.96), >25 y = 0.97 (95%CI, 0.81-0.99)) and OS5 (<11 y = 0.1, 11-25 y = 0.95 (95%CI, 0.87-0.99), >25 y = 0.97 (95%CI, 0.81-0.99)) did not demonstrate any statistically significant differences in outcomes.

CONCLUSIONS:

Patients diagnosed with dysgerminoma have an excellent OS, across all ages, even in the context of metastatic disease. Data from three large CTOs supports the investigation of carboplatin-based regimens in the frontline treatment of all patients with advanced-stage dysgerminoma to minimize treatment-related toxicities.

KEYWORDS:

Advanced-stage dysgerminoma; Malignant germ cell tumor international consortium (MaGIC); Malignant ovarian germ cell tumor (MOGCT); Pediatric, adolescent and young adult (AYA)

PMID:
29884437
DOI:
10.1016/j.ygyno.2018.05.025
[Indexed for MEDLINE]
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