Combination chemotherapy with paclitaxel, estramustine and carboplatin for hormone refractory prostate cancer.
Combination chemotherapy with paclitaxel, estramustine and carboplatin for hormone refractory prostate cancer.
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DOI：
10.1016/s0022-5347(05)64164-x
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发表时间：
2002-12
期刊：
影响因子：
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通讯作者：
S. Urakami;M. Igawa;N. Kikuno;Tateki Yoshino;H. Kishi;K. Shigeno;H. Shiina
中科院分区：
文献类型：
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作者：
S. Urakami;M. Igawa;N. Kikuno;Tateki Yoshino;H. Kishi;K. Shigeno;H. Shiina
目的磷酸雌二醇与紫杉醇对激素难治性前列腺癌具有协同作用。此外，卡铂的单药活性在可测量的疾病中显示出17%的缓解率。因此，我们进行了一项前瞻性试验，以建立由紫杉醇、磷酸雌二醇和卡铂组成的更有效的化疗方案来治疗激素难治性前列腺癌。材料与方法对32例激素难治性前列腺癌患者进行研究。既往接受化疗。患者以100 mg /m的剂量治疗。紫杉醇静脉滴注，每周10毫克/公斤。磷酸依雌莫司汀每日口服，卡铂每4周周期第1天静脉滴注至6曲线下区域。治疗一直持续到疾病进展或毒性过大。结果32例患者中30例可评估疗效。每例患者中位数为连续7个周期。10例患者先前接受过细胞毒性化疗。100%的患者前列腺特异性抗原水平下降了50%以上，56.7%的患者下降了90%以上。61.1%的可测量病变获得部分缓解。89.5%的患者减少了治疗癌症引起的疼痛的药物用量。81.0%的活检阳性患者表现出肿瘤体积缩小和/或抗肿瘤治疗效果。中位随访48周，中位进展时间为48周，中位总生存期为95周。2例患者分别发生心肌梗死和肝功能不全，在第一个周期停止治疗。主要毒性为3级或4级贫血（59.4%）、白细胞减少（37.5%）、血小板减少（28.1%）和神经病变（12.5%）。然而，所有的毒性都是暂时的，并且随着剂量的减少或化疗药物的暂时停止是可逆的。结论紫杉醇、磷酸雌氨莫司汀、卡铂联合化疗治疗激素难治性前列腺癌疗效显著。虽然血液学和神经毒性不大，但低剂量治疗可能更容易控制。
PurposeThe activity of estramustine phosphate is synergistic with paclitaxel against hormone refractory prostate cancer. Moreover, the single agent activity of carboplatin has demonstrated a 17% response rate in measurable disease. Therefore, we conducted a prospective trial to establish more effective chemotherapy consisting of paclitaxel, estramustine phosphate and carboplatin for hormone refractory prostate cancer.Materials and MethodsThe study included 32 patients with hormone refractory prostate cancer. Prior chemotherapy was accepted. Patients were treated with 100 mg./m.2paclitaxel intravenously weekly, 10 mg./kg. estramustine phosphate orally daily and carboplatin intravenously to an area under the curve of 6 on day 1 of every 4-week cycle. Treatment was continued until disease progression or excessive toxicity.ResultsOf the 32 patients 30 were assessable for response. A median of 7 consecutive cycles was administered per patient. Ten patients had received prior cytotoxic chemotherapy. Levels of prostate specific antigen decreased by greater than 50% in 100% of patients and by greater than 90% in 56.7%. Partial response was obtained in 61.1% of measurable lesions. Consumption of medication for cancer induced pain was reduced in 89.5% of patients. Tumor volume reduction and/or antitumor therapeutic effects were exhibited in 81.0% of patients with positive biopsy. At a median followup of 48 weeks median time to progression was 48 weeks and median overall survival was 95 weeks. Two patients suffered myocardial infarction and hepatic insufficiency, respectively, and discontinued treatment during the first cycle. Major toxicities were grade 3 or 4 anemia in 59.4% of patients, leukopenia in 37.5%, thrombocytopenia in 28.1% and neuropathy in 12.5%. However, all toxicity was temporary and reversible with dose reduction or temporary cessation of chemotherapeutic agents.ConclusionsPaclitaxel, estramustine phosphate and carboplatin chemotherapy was extremely effective for hormone refractory prostate cancer. Although hematological and neurotoxicity were modest, this therapy may be more manageable with lower doses.