Yagoda A, Petrylak D
Division of Medical Oncology, Columbia-Presbyterian Medical Center, New York, NY 10032-3789.
Cancer. 1993 Feb 1;71(3 Suppl):1098-109. doi: 10.1002/1097-0142(19930201)71:3+<1098::aid-cncr2820711432>3.0.co;2-g.
Advanced adenocarcinoma of the prostate after hormonal manipulation has been noted to be a relatively chemotherapeutic nonresponsive tumor. Earlier reviews have reported objective responses, that is, complete and partial remissions in 6.5% of 3184 patients, and the current review examines the efficacy of new agents.
The current review consists of 26 new drug trials culled from papers and abstracts published between 1987-1991.
Results of these 26 drug trials found a similar trend, 8.7% (95% confidence interval, 6.4-9.0%), indicating that hormone-resistant adenocarcinoma of the prostate still fails to respond to most cytotoxic agents. The most interesting of the new therapeutic agents is the combination of vinblastine plus estramustine. Only six agents had an objective response rate greater than 10%, such as vinblastine by continuous infusion, trimetrexate, mitoguazone, and estramustine. The recent introduction of radioactive-labeled monoclonal antibodies is intriguing and these will undoubtably be used as carriers for radiotherapeutic and cytotoxic compounds.
Although multidrug resistance may explain the marginal efficacy of cytotoxic drugs, methods to overcome such resistance and, more importantly, new classes of agents must be developed. In addition, reliable disease markers must be found for osseous and visceral metastases to avoid the prevailing confusion in evaluating more precisely the destruction of prostate cancer cells.
激素治疗后的晚期前列腺腺癌被认为是一种相对化疗无反应的肿瘤。早期综述报告了客观缓解情况，即在3184例患者中有6.5%实现了完全缓解和部分缓解，本综述考察了新型药物的疗效。
本综述包括从1987年至1991年发表的论文和摘要中筛选出的26项新药试验。
这26项药物试验的结果呈现出类似趋势，为8.7%（95%置信区间，6.4 - 9.0%），表明激素抵抗性前列腺腺癌对大多数细胞毒性药物仍然没有反应。最有意思的新型治疗药物是长春碱加雌莫司汀的组合。只有六种药物的客观缓解率超过10%，如持续输注长春碱、三甲曲沙、丙脒腙和雌莫司汀。近期引入的放射性标记单克隆抗体很有意思，无疑将用作放射治疗和细胞毒性化合物的载体。
尽管多药耐药可能解释细胞毒性药物的疗效不佳，但必须开发克服这种耐药性的方法，更重要的是，要开发新型药物。此外，必须找到用于骨转移和内脏转移的可靠疾病标志物，以避免在更精确评估前列腺癌细胞破坏情况时普遍存在的混淆。
