Pediatric and Adolescent Extracranial Germ Cell Tumors: The Road to Collaboration

• Authors: Thomas Olson, Emory University; Matthew J. Murray, Cambridge University Hospitals National Health Service (NHS) Foundation Trust; Carlos Rodriguez-Galindo, Boston Childrens Hospital; James C. Nicholson, Hospitals National Health Service (NHS) Foundation Trust; Deborah F. Billmore, Riley Hospital for Sick Children; Mark D. Krailo, University of Southern California; Ha M. Dang, University of Southern California; James F. Amatruda, University of Texas; Claire M. Thornton, Royal Victoria Hospital; G. Suren Arul, Birmingham Childrens Hospital NHS Foundation Trust; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust; Farzana Pashankar, Yale University; Daniel Stark, University of Leeds; Furqan Shaikh, The Hospital for Sick Children; David M. Gershenson, University of Texas; Allan Covens, University of Toronto; Jean Hurteau, University of Chicago; Sally P. Stenning, Medical Research Council; Darren R. Feldman, Memorial Sloan Kettering Cancer Center; Peter S. Grimison, Sydney Cancer Center; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital; Christopher Sweeney, Dana-Farber Cancer Institute; Thomas Powles, Barts Cancer Institute; Luiz Fernando Lopes, Barretos Pediatric Cancer Center; Simone dos Santos Agular, Centro Infantil Boldrini; Girish Chinnaswamy, Tata Memorial Hospital; Sahar Khaleel, Children's Cancer Hospital; Sherif Abouelnaga, Children's Cancer Hospital; Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust; A. Lindsay Frazier, Boston Children's Hospital
• Journal Title: Journal of Clinical Oncology
• Volume: Volume 33, Number 27
• Publisher: American Society of Clinical Oncology | 2015-09-20, Pages 3018-U119
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1200/JCO.2014.60.5337
• Subjects: Health Sciences, Oncology; Biology, Cell; Health Sciences, Rehabilitation and Therapy
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; CHILDRENS ONCOLOGY GROUP; HIGH-DOSE CHEMOTHERAPY; INTENSIVE INDUCTION CHEMOTHERAPY; COUNCIL EUROPEAN ORGANIZATION; RANDOMIZED PHASE-III; STAGE-I; TESTICULAR CANCER; UNITED-KINGDOM; COMBINATION CHEMOTHERAPY; YOUNG-ADULTS

Abstract

During the past 35 years, survival rates for children with extracranial malignant germ cell tumors (GCTs) have increased significantly. Success has been achieved primarily through the application of platinum-based chemotherapy regimens; however, clinical challenges in GCTs remain. Excellent outcomes are not distributed uniformly across the heterogeneous distribution of age, histologic features, and primary tumor site. Despite good outcomes overall, the likelihood of a cure for certain sites and histologic conditions is less than 50%. In addition, there are considerable long-term treatment-related effects for survivors. Even modest cisplatin dosing can cause significant long-term morbidities. A particular challenge in designing new therapies for GCT is that a variety of specialists use different risk stratifications, staging systems, and treatment approaches for three distinct age groups (childhood, adolescence, and young adulthood). Traditionally, pediatric cancer patients younger than 15 years have been treated by pediatric oncologists in collaboration with their surgical specialty colleagues. Adolescents and young adults with GCTs often are treated by medical oncologists, urologists, or gynecologic oncologists. The therapeutic dilemma for all is how to best define disease risk so that therapy and toxicity can be appropriately reduced for some patients and intensified for others. Further clinical and biologic insights can only be achieved through collaborations that do not set limitations by age, sex, and primary tumor site. Therefore, international collaborations, spanning different cooperative groups and disciplines, have been developed to address these challenges.