Sella A, Flex D, Konichezky M, Sulkes A, Baniel J
Department of Oncology, Rabin Medical Center, Beilinson Campus, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Eur Urol. 2000 Sep;38(3):255-8. doi: 10.1159/000020290.
Recent trials with modern chemotherapy have demonstrated activity in androgen-independent prostate cancer, but all focused on patients with progression following androgen suppression or antiandrogen withdrawal. Limited data are available on the activity of chemotherapy in androgen-independent, hormone-refractory (progressing following adrenal suppression) prostate cancer. We evaluated the activity of estramustine combined with vinblastine in this subset of androgen-independent prostate cancer.
From January 1995 until April 1999, 19 patients with hormone-refractory prostate cancer received estramustine 140 mg p.o., three times daily along with weekly vinblastine 5 mg/m(2).
A decrease in prostate-specific antigen of 50% or more was noted in 12 patients (63.1%, 95% CI 38.3-83.7%). The median decrease in prostate-specific antigen was 71.2% (range 50.5-85.2%). None of the 7 patients with measurable soft-tissue disease showed an objective response. The median survival from onset of chemotherapy was 6 (range 1.4-27.7) months and from initiation of adrenal suppression 16.9 (range 3.8-40. 5) months.
The combination of estramustine and vinblastine is capable of inducing activity in androgen-independent prostate cancer progressing after adrenal suppression. In our small sample, the survival rate was low, and we obtained no response in soft-tissue sites. Future prospective trials are needed to determine the benefit of sequential versus simultaneous incorporation of adrenal suppression with chemotherapy in the management of androgen-independent prostate cancer.
近期针对现代化疗的试验已证明其对雄激素非依赖性前列腺癌有活性，但所有试验均聚焦于雄激素抑制或抗雄激素撤药后病情进展的患者。关于化疗在雄激素非依赖性、激素难治性（肾上腺抑制后病情进展）前列腺癌中的活性的数据有限。我们评估了雌莫司汀联合长春碱在这一雄激素非依赖性前列腺癌亚组中的活性。
1995年1月至1999年4月，19例激素难治性前列腺癌患者接受口服雌莫司汀140mg，每日3次，同时每周接受长春碱5mg/m²治疗。
12例患者（63.1%，95%可信区间38.3 - 83.7%）的前列腺特异性抗原下降了50%或更多。前列腺特异性抗原的中位下降率为71.2%（范围50.5 - 85.2%）。7例有可测量软组织病变的患者均未显示客观缓解。化疗开始后的中位生存期为6（范围1.4 - 27.7）个月，肾上腺抑制开始后的中位生存期为16.9（范围3.8 - 40.5）个月。
雌莫司汀和长春碱联合用药能够在肾上腺抑制后病情进展的雄激素非依赖性前列腺癌中诱导活性。在我们的小样本中，生存率较低，且在软组织部位未获得缓解。未来需要进行前瞻性试验，以确定在雄激素非依赖性前列腺癌的治疗中，肾上腺抑制与化疗序贯或同时应用的益处。
