Safarinejad Mohammad Reza
Department of Urology, Urology Nephrology Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
Urol Oncol. 2005 Mar-Apr;23(2):93-101. doi: 10.1016/j.urolonc.2004.10.003.
To investigate more effective chemotherapy against hormone refractory prostate cancer (HRPC) with the combination of estramustine (EM), docetaxel, and suramin.
A total of 42 patients with symptomatic, progressive HRPC were included in this study. We evaluated the activity of the following schedule: EM 10 mg/kg orally daily on Days 1 to 21 every 28 days, docetaxel 70 mg/m(2) IV on Day 2 every 28 days and a total doses of 2150 mg of suramin in every cycle. Treatment was continued until disease progression or excessive toxicity.
Median follow-up was 23.4 months. A median of 8.8 consecutive cycles was administered per patient. In the 25 patients with lymphadenopathy, there were three (12%) complete and 18 (72%) partial responses for a measurable disease response rate of 84%. Levels of prostatic specific antigen (PSA) decreased by greater than 50% in 100% of patients and by greater than 90% in 76.2%. The median time to progression was 57 weeks and median overall survival was 132 weeks. A decline in PSA of > or =50% lasting > or =30 days was significantly associated with a prolonged median time to progression and median overall survival. Tumor volume reduction and/or antitumor treatment effects were observed in 88% of patients. A significant decrease in mean pain score from 7.8 (range, 6-10) to 2.2 (range, 0-4) (P < 0.001) was achieved in 78%. Of patients with bone metastasis, 30.5% demonstrated a partial response. The mean Eastern Cooperative Oncology Group (ECOG) performance score improved from 2.8 to 1.5 at the end of treatment period. There was no therapy-related death. The predominant toxicities were Grade 3 or 4 leukopenia in 33.3%, anemia in 21%, thrombocytopenia in 21.4%, cardiac ischemia in 4.7%, and rash in 4.7%.
The combination of docetaxel, EM, and suramin is a highly effective regimen for HRPC. Although hematologic and gastrointestinal toxicities were modest, these were easily managed medically.
研究雌莫司汀（EM）、多西他赛和苏拉明联合应用对激素难治性前列腺癌（HRPC）更有效的化疗方案。
本研究共纳入42例有症状的、进展期HRPC患者。我们评估了以下治疗方案的活性：每28天为一个周期，第1至21天口服EM 10 mg/kg，每28天的第2天静脉注射多西他赛70 mg/m²，每个周期苏拉明的总剂量为2150 mg。治疗持续至疾病进展或出现过度毒性。
中位随访时间为23.4个月。每位患者接受的中位周期数为8.8个连续周期。在25例有淋巴结病的患者中，有3例（12%）完全缓解，18例（72%）部分缓解，可测量疾病缓解率为84%。100%的患者前列腺特异性抗原（PSA）水平下降超过50%，76.2%的患者下降超过90%。中位疾病进展时间为57周，中位总生存期为132周。PSA下降≥50%且持续≥30天与延长的中位疾病进展时间和中位总生存期显著相关。88%的患者观察到肿瘤体积缩小和/或抗肿瘤治疗效果。78%的患者平均疼痛评分从7.8（范围6 - 10）显著降至2.2（范围0 - 4）（P < 0.001）。在有骨转移的患者中，30.5%表现出部分缓解。治疗期末，东部肿瘤协作组（ECOG）平均体能状态评分从2.8提高到1.5。无治疗相关死亡。主要毒性反应为3级或4级白细胞减少，发生率为33.3%；贫血，发生率为21%；血小板减少，发生率为21.4%；心脏缺血，发生率为4.7%；皮疹，发生率为4.7%。
多西他赛、EM和苏拉明联合应用是HRPC的一种高效治疗方案。尽管血液学和胃肠道毒性较轻，但通过医学手段易于处理。
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