Treatment Option Overview for Childhood Extracranial GCTs
The standard chemotherapy regimen for both adults and children with malignant nonseminomatous GCTs includes cisplatin, etoposide, and bleomycin. Adult patients receive weekly bleomycin throughout treatment (bleomycin, etoposide, and cisplatin [BEP]). Pediatric patients do not receive bleomycin during the weeks between cycles (cisplatin, etoposide, and bleomycin [PEB]). (Refer to Table 4 for adult BEP and pediatric PEB and JEB chemotherapy dosing schedules.)[1,2,13,14,15] The combination of carboplatin, etoposide, and bleomycin (JEB) underwent clinical investigation in the United Kingdom in children younger than 16 years and was reported to have an event-free survival (EFS) by site and stage similar to that of PEB.[3,16] The use of JEB appears to be associated with fewer otologic toxic effects and renal toxic effects than does the use of PEB. PEB and JEB have not been compared in a randomized pediatric GCT trial.
Adult studies have substituted standard-dose carboplatin for cisplatin in combination with etoposide alone and in combination with etoposide and low-dose bleomycin, but the carboplatin regimens demonstrated inferior EFS and overall survival (OS) compared with cisplatin-containing therapy among patients with malignant GCTs. No randomized comparison of PEB versus JEB has been conducted in children.
Refer to Table 4 for adult BEP and pediatric PEB and JEB chemotherapy dosing schedules.
Table 4. Comparison of Adult BEP and Pediatric PEB and JEB Chemotherapy Dosing Schedulesa
|BEP = bleomycin, etoposide, and cisplatin; GFR = glomerular filtration rate; JEB = carboplatin, etoposide, and bleomycin; PEB = cisplatin, etoposide, and bleomycin.
a Adult doses of PEB and JEB chemotherapy are different from pediatric doses.
b The adult BEP regimen is provided here for comparison only; BEP is not used in the treatment of children.
|Adult BEP (every 21 days)b[15,18]
||30 units/m2, days 1, 8, 15
||100mg/m2, days 1-5
||20 mg/m2, days 1-5
|Pediatric PEB (every 21 days)[1,2]
||15 units/m², day 1
||100 mg/m², days 1-5
||20 mg/m², days 1-5
|Pediatric JEB (every 21-28 days)
||15 units/m², day 3
||120 mg/m², days 1-3
||600 mg/m² or GFR-based dosing, day 2