Kelly W K, Curley T, Leibretz C, Dnistrian A, Schwartz M, Scher H I
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Clin Oncol. 1995 Sep;13(9):2208-13. doi: 10.1200/JCO.1995.13.9.2208.
To assess efficacy of intermittent infusion of suramin in patients with androgen-independent prostate cancer who have had disease progression on hydrocortisone.
Chemotherapy-naive patients with progressive androgen-independent prostate cancer were given hydrocortisone 40 mg/d and monitored for treatment effect. At the time of disease progression, suramin was administered on a pharmacokinetically derived, 2-week dosing schedule.
Thirty patients with a median Karnofsky performance status (KPS) of 90% were treated with hydrocortisone. No responses were seen in 12 patients with measurable disease or 29 patients with abnormal bone scans. Thirty patients had an increasing prostate-specific antigen (PSA) level before treatment and six (20%) had a more than 50% decline in PSA from the baseline value for a median of 16 weeks (range, 12 to 52+). Twenty-eight patients had disease progression after a median of 7 weeks (range, 3 to 23), and two patients have continued to receive hydrocortisone for 44 and 52 weeks. Twenty-eight patients received hydrocortisone and suramin, with median suramin concentrations of 97 to 170 micrograms/mL for 4 weeks. No responses in measurable disease and no improvements in bone scans were seen. Five patients (18%) showed a more than 50% decline in PSA levels from baseline, of whom three had previously responded to hydrocortisone. Only two of 24 patients who did not show a posttherapy decline in PSA levels after hydrocortisone had a reduction in PSA levels with the addition of suramin. Toxicity profiles were acceptable with each agent, although a higher proportion of subjects showed hematologic, cardiac, and neurologic events when suramin was added.
Suramin has limited efficacy in patients with androgen-independent prostate cancer who have had disease progression after hydrocortisone.
评估苏拉明间歇输注对已接受氢化可的松治疗但病情仍进展的雄激素非依赖性前列腺癌患者的疗效。
未接受过化疗的雄激素非依赖性前列腺癌进展期患者给予氢化可的松40mg/d，并监测治疗效果。疾病进展时，按照药代动力学推导的2周给药方案给予苏拉明。
30例患者接受氢化可的松治疗，卡氏功能状态评分（KPS）中位数为90%。12例可测量疾病患者和29例骨扫描异常患者均未出现反应。30例患者治疗前前列腺特异性抗原（PSA）水平升高，6例（20%）PSA水平较基线值下降超过50%，中位持续时间为16周（范围12至52 +周）。28例患者在中位7周（范围3至23周）后疾病进展，2例患者继续接受氢化可的松治疗44周和52周。28例患者接受了氢化可的松和苏拉明治疗，苏拉明浓度中位数为97至170μg/mL，持续4周。可测量疾病未出现反应，骨扫描也无改善。5例患者（18%）PSA水平较基线下降超过50%，其中3例先前对氢化可的松有反应。氢化可的松治疗后PSA水平未下降的24例患者中，仅2例加用苏拉明后PSA水平降低。每种药物的毒性反应均可接受，不过加用苏拉明时，出现血液学、心脏和神经系统事件的受试者比例更高。
对于在接受氢化可的松治疗后病情进展的雄激素非依赖性前列腺癌患者，苏拉明的疗效有限。
