"He went through six operations and was placed on a clinical trial so he could try new treatments.”
A trial looking at treatment for children and teenagers with germ cell tumours (GC 2005 04)
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Please note - this trial is no longer recruiting patients. We hope to add results when they are available.
This trial is trying to improve the treatment for children and teenagers with germ cell tumours.
This trial is for children and young people up to their 18th birthday. We use the term ‘you’ in this summary, but of course if you are a parent, we are referring to your child.
Germ cell tumours are quite rare, but are most common in children and young adults. The tumours begin in the reproductive cells of the body, the eggs and sperm. Because they begin in the eggs and sperm most germ cell tumours develop in the ovaries or testicles. But during development of a baby in the womb the cells can also travel to other parts of the body. So tumours may develop elsewhere, for example in the stomach.
In the UK, germ cell tumours are usually treated with surgery alone, or with surgery followed by chemotherapy. The treatment works well in most children and 9 out of 10 are cured of their cancer. But of course doctors want to improve on this.
Doctors recognise that chemotherapy has side effects and want to find out if some of the children can have less chemotherapy or none at all, while still being cured.
Germ cell tumours produce substances called markers and these are measured by a blood test. These markers are AFP (alpha feta protein) and HCG (human chorionic gonadotropin). Doctors follow the marker levels to find out if treatment is working. In a previous trial for germ cell tumours, children had chemotherapy until their marker levels had returned to normal. They then had 2 more course of chemotherapy. So children had about 5 or 6 courses of chemotherapy in total.
The doctors recruiting patients into this trial want to decide on the amount of chemotherapy in a slightly different way. They will look at
- Where the tumour started
- Whether it has spread or not
- The level of AFP in the blood
This will mean that some children will have less chemotherapy than they would have done in the past. If this is found to be a better way or as good a way of treating germ cell tumours, while reducing side effects, it will be used for children and teenagers in the future.
Who can enter
You can enter this trial if you
- Have recently been diagnosed with extracranial (outside the brain) germ cell tumour, or mature or immature teratoma
- Have satisfactory blood test results
- Are aged between 0 years up to your 18th birthday
You cannot enter this trial if you
- Have a germ cell tumour that is intracranial (inside the brain)
- Have already had chemotherapy
- Are pregnant or breastfeeding
This national trial aims to recruit about 100 children and teenagers with germ cell tumours over 5 years.
You may have already had an operation to remove as much of your tumour as possible by the time you are recruited on to this trial. If not, the doctors will decide whether it is possible for you to have an operation.
There are 3 treatment groups. Your doctor will decide which group you are in depending on
- Where the tumour started
- Whether it has spread or not
- The level of AFP in your blood
The groups are called ‘low risk’, ‘intermediate risk’ and ‘high risk’. This is to do with the risk of your tumour coming back (recurring).
If you are in this group, you will not have chemotherapy following your surgery. You will be closely monitored. If a scan shows that the cancer has come back, or if the level of AFP rises, your doctor will then consider chemotherapy. In that case, you will become part of the intermediate or high risk group.
If you are in this group, you have chemotherapy every day for 3 days into your central line. You have etoposide over about 4 hours every day. On day two, you also have carboplatin over about 1 hour. On day three, you also have bleomycin over about 30 minutes. This will be repeated every 3 weeks.
This 3 week period is called a ‘cycle’ of chemotherapy. You have 4 cycles, over about 3 months.
After chemotherapy you will have a scan. If this shows that there is still some cancer left behind, your doctor may talk to you about the possibility of further surgery to remove it.
If you are in this group, you have the same chemotherapy as the intermediate risk group. But you have 6 cycles of chemotherapy, over about 4 and a half months.
After chemotherapy you will have a scan. If this shows that there is still some cancer left behind, your doctor may talk to you about the possibility of surgery to remove it.
You will see a doctor for examinations and tests before treatment starts. These include
- A scan of your cancer, this may be an X-ray, CT scan, MRI scan or ultrasound scan
- Chest X-ray
- Bone scan
- Blood tests
- Hearing tests (audiogram)
You have some of these tests again during and after treatment.
The treatment for your germ cell tumour is very intensive, whether you take part in this trial or not. You will not have extra tests or treatment as a result of taking part in this trial.
After treatment has finished, you will continue to see the doctor regularly for many years. These appointments will be arranged with you individually and will probably become less frequent as time passes.
All treatments have side effects. The most common side effects of chemotherapy are
- A drop in blood cells causing an increased risk of infection, bleeding problems, tiredness and breathlessness
- Hair loss
- Feeling or being sick
- Dry and sore mouth
How to join a clinical trial
Dr J. Hale
Cancer Research UK Children's Cancer Trials Team
University of Birmingham
NIHR Clinical Research Network: Cancer