Dupont A, Labrie F, Giguere M, Borsanyi J P, Lacourciere Y, Bergeron N, Cusan L, Belanger A, Emond J
Department of Molecular Endocrinology, Laval University Medical Center, Quebec, Canada.
Eur J Cancer Clin Oncol. 1988 Apr;24(4):659-66. doi: 10.1016/0277-5379(88)90296-9.
Sixty-seven previously untreated patients presenting with clinical stage C prostatic carcinoma with no evidence of distant metastases received combination therapy using the antiandrogen Flutamide and the LHRH agonist [D-Trp6]LHRH ethylamide for an average duration of treatment of 23.5 months. Only five patients have so far shown treatment failure with 91.8% of the patients still in remission at 2 years. Three patients have died from prostate cancer while three have died from other causes, 93.5% of the patients being alive at 2 years. Local control was achieved rapidly in all except one patient. Urinary obstruction and hydronephrosis were corrected in all cases. When comparing to recent data obtained after single endocrine therapy (orchiectomy or estrogens), or radiotherapy, the rate of treatment failure at 2 years is 3.5-fold lower after combination therapy (8.2%) than monotherapy (28.4%). The death rate at 2 years following start of the combination therapy is 6.5% while it is on average 22.2% (3.4-fold higher) in the studies using monotherapy (orchiectomy or estrogens) or radiotherapy. The present data suggest that treatment of prostate cancer with combination therapy before clinical evidence of dissemination of the disease permits a better response which is possibly explained, at least in part, by the lower degree of dedifferentiation and heterogeneity of the tumors.
67例既往未经治疗、临床分期为C期且无远处转移证据的前列腺癌患者接受了抗雄激素药物氟他胺和促黄体生成素释放激素（LHRH）激动剂[D-色氨酸6]LHRH乙酰胺的联合治疗，平均治疗时间为23.5个月。目前仅有5例患者出现治疗失败，91.8%的患者在2年时仍处于缓解状态。3例患者死于前列腺癌，3例死于其他原因，93.5%的患者在2年时仍存活。除1例患者外，所有患者均迅速实现了局部控制。所有病例的尿路梗阻和肾积水均得到纠正。与近期单内分泌治疗（睾丸切除术或雌激素）或放疗后获得的数据相比，联合治疗后2年的治疗失败率（8.2%）比单一疗法（28.4%）低3.5倍。联合治疗开始后2年的死亡率为6.5%，而在使用单一疗法（睾丸切除术或雌激素）或放疗的研究中，平均死亡率为22.2%（高3.4倍）。目前的数据表明，在疾病出现临床播散证据之前采用联合疗法治疗前列腺癌可获得更好的反应，这至少部分可能是由于肿瘤的去分化程度和异质性较低。
