Russo P, Liguori G, Heston W D, Huryk R, Yang C R, Fair W R, Whitmore W F, Herr H W
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Cancer Res. 1987 Nov 15;47(22):5967-70.
Clinical trials have utilized intermittent diethylstilbestrol diphosphate (DES) therapy in advanced symptomatic prostatic carcinoma to diminish the morbidity of standard endocrine therapy. To determine the effect of intermittent DES administration on the Dunning R3327 rat prostatic adenocarcinoma 60 days following tumor implant, 6 groups were randomly assigned: control (N = 8), castrate (N = 10), high dose DES (N = 8, 1.6 micrograms/ml DES continuously in drinking water), low dose DES (N = 10, 0.4 microgram/ml continuously in drinking water), intermittent high dose DES (N = 10, 1.6 micrograms/ml DES in drinking water for 1 week, then off for 3 weeks), and intermittent low dose DES (N = 10, 0.4 microgram/ml DES for 1 week, then off for 3 weeks). Results indicate that low or high dose DES, and intermittent low or intermittent high dose DES during the week of administration were able to reduce serum testosterone to castrate levels (0.1 ng/ml). After withdrawal of intermittent DES, serum testosterone returned toward control levels (1.0 ng/ml). Initial mean tumor burden between control and treatment groups was not significantly different. All DES exposed rats had a tumor volume at death (range, 15.6-18.3 cm3) smaller than control (mean, 25.4 cm3) or castrate (mean, 40.8 cm3) rats. Despite this significant survival advantage from the time of randomization was achieved only in castrate (median survival, 331 days) or high dose DES (median survival, 359 days) groups compared to control (median survival, 225 days). Similarly, significant prolongation in tumor doubling time was achieved only by rats receiving castration or high dose DES. Intermittent DES administration controls tumor volume but does not provide a survival advantage. In this respect, intermittent DES is inferior to castration.
临床试验已采用间歇性己烯雌酚二磷酸酯(DES)疗法治疗晚期有症状的前列腺癌,以降低标准内分泌治疗的发病率。为了确定在肿瘤植入60天后间歇性给予DES对Dunning R3327大鼠前列腺腺癌的影响,将6组大鼠随机分组:对照组(N = 8)、去势组(N = 10)、高剂量DES组(N = 8,饮用水中持续含1.6微克/毫升DES)、低剂量DES组(N = 10,饮用水中持续含0.4微克/毫升DES)、间歇性高剂量DES组(N = 10,饮用水中含1.6微克/毫升DES 1周,然后停药3周)和间歇性低剂量DES组(N = 10,饮用水中含0.4微克/毫升DES 1周,然后停药3周)。结果表明,在给药的一周内,低剂量或高剂量DES以及间歇性低剂量或间歇性高剂量DES均能够将血清睾酮水平降至去势水平(0.1纳克/毫升)。间歇性DES停药后,血清睾酮水平恢复至对照水平(1.0纳克/毫升)。对照组和治疗组之间的初始平均肿瘤负荷无显著差异。所有接受DES治疗的大鼠死亡时的肿瘤体积(范围为15.6 - 18.3立方厘米)均小于对照组(平均为25.4立方厘米)或去势组(平均为40.8立方厘米)大鼠。尽管如此,与对照组(中位生存期为225天)相比,仅去势组(中位生存期为331天)或高剂量DES组(中位生存期为359天)从随机分组时起就获得了显著的生存优势。同样,仅接受去势或高剂量DES的大鼠实现了肿瘤倍增时间的显著延长。间歇性给予DES可控制肿瘤体积,但未提供生存优势。在这方面,间歇性DES不如去势治疗。