Estramustine Phosphate Based Chemotherapy for Hormone Refractory Prostate Cancer

Abstract

Purpose: We wanted to evaluate the efficacy and side effects of estramustine monotherapy and estramustine plus etoposide or dexamethasone combined therapies for patients with hormone refractory prostate cancer (HRPC). Materials and Methods: Between 2000 and 2004, 33 patients who were diagnosed with HRPC and treated with estramustine-based chemotherapy were evaluated. Eleven patients had oral estramustine monotherapy (group 1), 12 patients had oral estramustine plus oral etoposide (group 2), and finally 10 patients had oral estramustine plus oral dexamethasone (group 3). The prostate-specific antigen (PSA) response, progression-free survival and disease-specific survival were evaluated. Results: The median patient age was 71 years and the median PSA was 97.3ng/ml. The median follow-up period was 17 months (range: 5-47). The overall response rate was 45.5%, and the response rate for each group was 36.4% for group 1, 41.7% for group 2 and 70.0% for group 3, respectively. The median time to progression (TTP) was 5 months (range: 1-16) overall and it was 5 months, 5.5 months and 5 months in groups 1, 2 and 3, respectively. Regarding the response rate, progression-free survival and disease specific survival, there were no statistically significant differences between the three groups (p>0.05). The most common hematologic complication was anemia that occurred in 28 patients and deep vein thrombosis occurred in 2. Severe toxicities (≥grade 3) occurred in only 2 patients. Conclusions: Estramustine phosphate showed over a 45% response rates with less morbidities. Estramustine-based chemotherapy can be considered as an option for the treatment of HRPC. However, larger randomized controlled trials for regimens combined with other efficacious agents are necessary to elucidate the efficacy of chemotherapy for HRPC. (Korean J Urol 2007;48:684-690) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏