Hellerstedt Beth, Pienta Kenneth J, Redman Bruce G, Esper Peg, Dunn Rodney, Fardig Judith, Olson Karin, Smith David C
Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan 48109, USA.
Cancer. 2003 Oct 15;98(8):1603-10. doi: 10.1002/cncr.11686.
The authors evaluated the combination of oral cyclophosphamide, oral prednisone, and diethylstilbestrol (DES) in patients with androgen-independent prostate carcinoma (AIPC).
Thirty-seven patients with prostate carcinoma refractory to androgen ablation who had undergone antiandrogen withdrawal (if previously treated with an antiandrogen) were enrolled in the current study. They were treated with oral cyclophosphamide 100 mg per day on Days 1-20, prednisone 10 mg per day continuously, and DES 1 mg continuously, on a 30-day cycle. Warfarin 1 mg per day was given as prophylaxis for thrombosis. Patient levels of prostate-specific antigen (PSA) were monitored on a monthly basis, with imaging studies every 3 months. Patients continued to receive therapy until disease progression or the occurrence of significant toxicity. The effect of therapy on the patient's quality of life was assessed using the Functional Assessment of Cancer Therapy-Prostate.
Thirty-six patients were evaluable for response. Of the 36 patients, 15 (42%) had a 50% or greater decline in PSA levels from pretreatment levels and 1 patient (6%) with measurable disease had a partial response to therapy. The median duration of response was 4.5 months (range, 4-18 months). The overall median survival period was 16.4 months. The treatment was well tolerated, with only three patients removed from the study for toxicities associated with treatment. One patient, who had been treated for more than 24 months, developed acute leukemia. Quality of life evaluation in 17 patients showed a significant improvement in responders, whereas nonresponders had no deterioration while receiving therapy.
Cyclophosphamide, prednisone, and DES represent a well tolerated, low-cost combination therapy with significant activity in the treatment of patients with AIPC.
作者评估了口服环磷酰胺、口服泼尼松和己烯雌酚（DES）联合应用于雄激素非依赖性前列腺癌（AIPC）患者的疗效。
37例雄激素去除治疗无效且已停用抗雄激素药物（若之前接受过抗雄激素治疗）的前列腺癌患者纳入本研究。他们接受为期30天的治疗周期，第1 - 20天每天口服环磷酰胺100毫克，持续每天口服泼尼松10毫克，持续口服DES 1毫克。每天给予1毫克华法林预防血栓形成。每月监测患者前列腺特异性抗原（PSA）水平，每3个月进行影像学检查。患者持续接受治疗直至疾病进展或出现严重毒性反应。使用癌症治疗功能评估 - 前列腺量表评估治疗对患者生活质量的影响。
36例患者可评估疗效。在这36例患者中，15例（42%）PSA水平较治疗前下降50%或更多，1例（6%）可测量病灶的患者对治疗有部分反应。中位反应持续时间为4.5个月（范围4 - 18个月）。总体中位生存期为16.4个月。该治疗耐受性良好，仅有3例患者因与治疗相关的毒性反应退出研究。1例接受治疗超过24个月的患者发生急性白血病。17例患者的生活质量评估显示，有反应者有显著改善，而无反应者在接受治疗期间无恶化。
环磷酰胺、泼尼松和DES是一种耐受性良好、低成本的联合治疗方案，对AIPC患者具有显著的治疗活性。
