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

• Published in: Gynecologic oncology 2018-08, Vol.150 (2), p.253-260
• Main Authors: Shah, Rachana, Xia, Caihong, Krailo, Mark, Amatruda, James F., Arul, Suren G., Billmire, Deborah F., Brady, William E., Covens, Allan, Gershenson, David M., Hale, Juliet P., Hurteau, Jean, Murray, Matthew J., Nicholson, James C., Olson, Thomas A., Pashankar, Farzana, Rodriguez-Galindo, Carlos, Shaikh, Furqan, Stark, Daniel, Frazier, A. Lindsay, Stoneham, Sara
• Format: Article
• Language: English
• Subjects: Advanced-stage dysgerminoma; Malignant germ cell tumor international consortium (MaGIC); Malignant ovarian germ cell tumor (MOGCT); Pediatric, adolescent and young adult (AYA)
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2018.05.025

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  25 y) for advanced-stage dysgerminoma. 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. 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 (25 y = 0.97 (95%CI, 0.81–0.99)) and OS5 (25 y = 0.97 (95%CI, 0.81–0.99)) did not demonstrate any statistically significant differences in outcomes. 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. •Patients with pure ovarian dysgerminoma have excellent survival outcomes regardless of the age or stage at diagnosis.•Fertility-sparing surgery should be encouraged in the frontline management of dysgerminoma, when feasible.•In this analysis, carboplatin is not shown to be inferior to cisplatin-based chemoth