Amato Robert J, Teh Bin S, Henary Haby, Khan Muhammad, Saxena Somyata
Genitourinary Oncology Program, The Methodist Hospital Research Institute, Houston, TX 77030, USA.
Urol Oncol. 2009 Mar-Apr;27(2):165-9. doi: 10.1016/j.urolonc.2007.12.004. Epub 2008 Mar 4.
Chemotherapy for hormone-refractory prostate cancer reduces PSA levels and enhances overall survival (OS), suggesting that administration in earlier disease stages may be beneficial. If expansion of an androgen-independent clone present during androgen deprivation mediates the transformation from an androgen-dependent to an androgen-independent phenotype, combination chemohormonal therapy would be effective initial treatment for locally advanced or metastatic prostate cancers. A retrospective review was conducted to evaluate results.
Chemohormonal therapy outcomes were retrospectively evaluated in men with locally advanced or metastatic prostate cancer seen at our institution between January 2001 and February 2003. Chemotherapy consisted of three 8-week cycles (once weekly intravenous doxorubicin 20 mg/m(2) and thrice daily oral ketoconazole 400 mg in weeks 1, 3, and 5; once weekly intravenous docetaxel 35 mg/m(2) and thrice daily oral estramustine 280 mg in weeks 2, 4, and 6; and no therapy in weeks 7 and 8). Hormone therapy consisted of hormonal ablation during and after antiandrogen therapy after chemotherapy.
Data for 31 men (median age, 63 years [range, 41-74 years]; white, 97% [30/31]) were reviewed. At 1 year, median PSA level had fallen 99.3% (range, 91.7%-99.9%) from a baseline value of 14.3 ng/ml (range, 1.9-497.9 ng/mL). Median time to progression was 34+ months (range, 14-68+ months). Median OS was 56+ months (range, 17-73+ months).
Combination chemohormonal therapy for locally advanced or metastatic prostate cancer safely and effectively reduces PSA levels and increases OS. We are now testing this approach in a prospective, Phase II randomized clinical trial.
激素难治性前列腺癌的化疗可降低前列腺特异抗原（PSA）水平并提高总生存期（OS），这表明在疾病早期阶段进行化疗可能有益。如果在雄激素剥夺期间出现的雄激素非依赖克隆的扩增介导了从雄激素依赖表型向雄激素非依赖表型的转变，那么联合化学激素疗法将是局部晚期或转移性前列腺癌有效的初始治疗方法。进行了一项回顾性研究以评估结果。
对2001年1月至2003年2月期间在我们机构就诊的局部晚期或转移性前列腺癌男性患者的化学激素治疗结果进行回顾性评估。化疗包括三个8周周期（第1、3和5周，每周静脉注射阿霉素20mg/m²，每日口服酮康唑400mg三次；第2、4和6周，每周静脉注射多西他赛35mg/m²，每日口服雌莫司汀280mg三次；第7和8周不进行治疗）。激素治疗包括化疗后抗雄激素治疗期间及之后的激素去除。
对31名男性患者（中位年龄63岁[范围41 - 74岁]；白人占97%[30/31]）的数据进行了回顾。1年后，中位PSA水平从基线值14.3ng/ml（范围1.9 - 497.9ng/mL）下降了99.3%（范围91.7% - 99.9%）。中位进展时间为34 +个月（范围14 - 68 +个月）。中位总生存期为56 +个月（范围17 - 73 +个月）。
联合化学激素疗法治疗局部晚期或转移性前列腺癌安全有效，可降低PSA水平并延长总生存期。我们目前正在一项前瞻性II期随机临床试验中测试这种方法。
