Inclusion Criteria: 1. Progressive metastatic GCTs of gonadal or extragonadal origin in males after failure of front-line therapy and at least one salvage regimen. 2. Must have evaluable or measurable disease by clinical or radiological studies. Alternatively, in the absence of radiologically evaluable or measurable disease, two sequentially rising marker values each one week apart attributed by treating physician to germ cell tumor is permitted; either beta HCG above 50 mIU/ml and/or AFP above 20 ng/ml qualifies as eligible. 3. ECOG Performance Score 0-2 4. Adequate organ function as follows: Calculated creatinine clearance >/= 35cc/min, Absolute neutrophil count >/= 1500/mm^3, hemoglobin >/= 8 g/dL, serum calcium mg/dL, Platelet count >/= 75,000/mm^3, AST/ALT < 2.5 x ULN, Total bilirubin < 2.0mg/dl. 5. Resolution of all acute toxic effects of prior chemotherapy or radiotherapy or surgical procedures to NCI CTCAE Version 3.0 grade 6. At least 18 years of age as safety of sunitinib in a pediatric population has not been established. 7. Able to provide informed consent 8. Must be able to ingest oral medication 9. Male subjects must be surgically sterile or must agree to use effective contraception during the period of therapy. The definition of effective contraception will be based on the judgment of the principal investigator or a designated associate. 10. Patients who have not received prior high-dose chemotherapy and stem cell rescue as salvage therapy will have this option discussed with them. Only patients ineligible, unwilling or unable to undertake this option will be eligible for this trial. Exclusion Criteria: 1. NCI CTCAE Version 3.0 grade 3 hemorrhage within the 4 weeks prior to starting the study treatment. 2. Any of the following within the 12 months prior to study drug administration: myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass graft, symptomatic congestive heart failure, cerebrovascular accident or transient ischemic attack, or pulmonary embolism. 3. Patients with history of Long QT syndrome. 4. Ongoing cardiac dysrhythmias of NCI CTCAE Version 3.0 grade >/= 2. 5. Uncontrolled Hypertension (> 140/90 mm Hg despite optimal medical therapy). 6. Pre-existing thyroid abnormality with thyroid function that cannot be maintained in the normal range with medication. 7. Symptomatic bowel obstruction. 8. Prior VEGFR/PDGFR inhibitor therapy. 9. Known human immunodeficiency virus infection, chronic active hepatitis or liver cirrhosis.
Purpose
The Study Drug:
Sunitinib malate is designed to block pathways that control important events such as the growth of blood vessels that are essential for the growth of cancer.
Screening Tests:
Within 28 days before enrollment on this study, you will have the following tests and procedures performed:
- To check the status of the disease, you will have a chest x-ray, and computed tomography (CT) scans of your chest, abdomen (stomach area), and pelvis.
- You will have a magnetic resonance imaging (MRI) of your brain.
- You will have an electrocardiogram (ECG--a test to measure the electrical activity of the heart) and an echocardiogram or MUGA scan to check your heart's health.
Within 14 days of enrollment on this study, you will have the following tests and procedures performed:
- Your complete medical history will be recorded.
- You will have a physical exam.
Within 7 days of enrollment on this study, you will have the following tests and procedures performed:
-Blood (about 3 teaspoons) and urine will be collected for routine testing and to test for certain biomarkers (to check the status of the disease).
Study Drug Administration:
If you are found to be eligible to take part in this study, you will take sunitinib malate capsules once a day (by mouth) for 4 weeks in a row followed by 2 weeks with no study drug. These 6 weeks are considered 1 cycle of study treatment.
Study Visits:
On Day 1 of each cycle (about every 6 weeks), you will have the following tests done before you take the study drug:
- You will have a physical exam.
- You will be asked about how you are feeling and about any side effects you have experienced since your last visit.
- You will have blood (about 3 teaspoons) and urine collected for routine tests and to test for certain biomarkers.
For the first 4 weeks of treatment, you should have your blood pressure monitored. This may be done at your home with a digital pressure device, or you may visit your local doctor for this testing.
About Day 21 of Cycles 1 and 2, blood (about 2- 3 teaspoons) will be drawn for routine tests.
On Day 1 of Cycle 2, Day 1 of Cycle 3, and then Day 1 of every 2 cycles after that (Cycle 5, Cycle 7, and so on), you will have imaging scans to check status of the disease. This could include CT or MRI scans, an ECG, and a chest x-ray. If your doctor thinks it is necessary, you may have additional imaging scans at any time.
On Day 1 of every other cycle (Cycle 3, Cycle 5, and so on), you will have an echocardiogram or MUGA scan.
Length of Study:
You may remain on study for as long as you are benefitting. You will be taken off study if intolerable side effects occur or if the disease gets worse. However, if the disease gets worse very quickly during Cycles 1 or 2, you will be taken off study at that time.
End-of-Study Visit:
About 30 days after your last dose of sunitinib, you will have an end-of-study visit. At this visit, the following tests and procedures will be performed:
- You will have a physical exam.
- You will be asked how you are feeling and about any changes in your medical history since beginning this study.
- You will also be asked about any side effects you have experienced since your last visit.
This is an investigational study. Sunitinib malate is approved by the FDA for the treatment of adults with kidney cancer. Up to 42 patients will take part in this study. All will be enrolled at M. D. Anderson.
Interventions
Drug: Sunitinib Malate
50 mg capsules once a day (by mouth) for 4 weeks in a row in a 6 week cycle.
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