A study testing a treatment for people with a germ cell tumour that has come back (GAMMA)

Cancer type:

Ovarian cancer
Testicular cancer




Phase 2

This study is testing a different combination of chemotherapy drugs for people with a cancerous germ cell tumour that has come back after treatment. A germ cell tumour develops from the cells that become eggs or sperm.

More about this trial

Doctors usually treat cancerous germ cell tumours with surgery and chemotherapy. If the tumour comes back, you would usually have more chemotherapy. Researchers have completed a trial looking at a combination of the chemotherapy drugs actinomycin Dmethotrexateetoposide and cisplatin for people in this situation.

This treatment was very successful in men who had a germ cell tumour in the testicle (testicular cancer) that had come back after treatment. But when they looked more closely at the results they found that older patients, those with a raised biomarker Open a glossary item called lactate dehydrogenase (LDH) and those whose original tumour had started in their chest did not do so well. So in this study, the researchers have replaced etoposide and cisplatin with drugs called paclitaxel and oxaliplatin, which also work well in treating germ cell tumours.

The aim of this study is to see if this combination works better and has fewer side effects compared with the team’s original treatment.

The people taking part have cancer that their doctors think is at risk of coming back after standard treatment Open a glossary item.

Who can enter

You may be able to enter this study if

  • You have a cancer that developed from the cells that become sperm or eggs (germ cell tumour Open a glossary item)
  • You have had treatment with chemotherapy that included a platinum drug Open a glossary item but your cancer has come back or continued to grow
  • You have satisfactory blood test results
  • A blood or urine test shows that your kidneys are working well enough to flush out the chemotherapy
  • You are willing to use reliable contraception during the study if there is any chance that you or your partner could become pregnant
  • You are between 16 and 65 years old

You cannot enter this study if you

  • Have had any other cancer apart from basal cell skin cancer
  • Have already had oxaliplatin, methotrexate or actinomycin D chemotherapy
  • Are already taking part in another clinical trial of an experimental drug
  • Are in a bed or chair all the time and need a lot of looking after (you have a performance status of 4)
  • Have numbness or tingling in your hands or feet (peripheral neuropathy Open a glossary item), and this makes it hard to do day to day tasks
  • Have any other condition that would make you unwell if you took part – you can ask your doctor about this

Trial design

This study will recruit up to 43 people. An independent team will look at the safety results after 15 people have taken part. If results are satisfactory, the study team will continue until they have recruited 43 people.

Everyone taking part will have the new combination of chemotherapy. You have the chemotherapy through a drip into a vein, in 3 week cycles of treatment. You have

  • Actinomycin D, methotrexate and paclitaxel on day 1
  • Oxaliplatin on day 4
  • Paclitaxel and oxaliplatin on day 8
  • Paclitaxel again on day 15

You also have a drug called pegfilgrastim as an injection under your skin on day 3 of each cycle. This is to help stimulate your bone marrow to make more white blood cells to replace those killed off by the chemotherapy.

Hospital visits

Before the study, you will see the doctor and have some tests to see if you are suitable to join.  These tests include

  • Physical examination
  • Blood tests
  • Kidney function test
  • PET scan if needed

At the start of each cycle of treatment you stay in hospital for 2 nights, as you have the treatment continuously for just over 48 hours. You finish the drip on the morning of day 3, have your pegfilgrastim injection and then go home. You come to hospital again on day 8 and day 15 for more treatment as an out patient.

You have 3 PET-CT scans or 1 PET-CT scan and 2 CT scans during your treatment. After you finish treatment you see the study team

  • Every month for a year
  • Every 4 months for the second year

If you are one of the first 3 people taking part, you miss the day 8 visits for paclitaxel, but have an extra cycle of treatment at the end.

Side effects

Side effects of the chemotherapy used in this study include

You can find out more about pegfilgrastim, actinomycin D, methotrexate, paclitaxel and oxaliplatin in our cancer drugs section.



Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Dr Jonathan Shamash

Supported by

Barts Health NHS Trust
Experimental Cancer Medicine Centre (ECMC)
Orchid Cancer Appeal
Orchid Clinical Trials Group

Questions about cancer? Contact our information nurses

Freephone 0808 800 4040

Last review date

CRUK internal database number:


Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Cara took part in a clinical trial

A picture of Cara

"I am glad that taking part in a trial might help others on their own cancer journey.”

Last reviewed:

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