Prompt resolution of acute disseminated intravascular coagulation with docetaxel and cisplatin in hormone refractory prostate cancer.

Abstract

A 72-year-old man with hormone refractory prostate cancer presented with spontaneous cutaneous petechiae and bleeding at incision foci. He had been receiving leuprolide for more than 7 years for prostate cancer with bone metastases, which had been diagnosed when biopsy demonstrated liver involvement with classic prostate adenocarcinoma cells. At presentation serum prostate specific antigen (PSA) was 44 ng./ml. and neuron specific enolase (NSE) was 86 ng./ml. (normal less than 15). Platelet count was 19,000/ml. (normal 150,000 to 300,000), hemoglobin 12 gm./dl. (normal 12 to 14), fibrinogen 0.7 gm./l. (normal 2 to 4) and D-dimer test was positive. The patient was administered 75 mg./m. 2 docetaxel intravenously and 70 mg./m. 2 cisplatin intravenously on day 1. Platelet count increased to 70,000/ml., fibrinogen increased to 1.2 gm./l. and hemorrhagic diathesis was controlled by day 3 after treatment. Coagulase tests normalized within 1 week. The patient was subsequently treated every 3 weeks for a total of 4 cycles. PSA nadir was 2.8 ng./ml. immediately after the last cycle of chemotherapy, while serum NSE decreased to below normal after the first cycle. At 12 months of followup the patient had a good performance status with normal hematological parameters but PSA had increased to 9.6 ng./ml. DISCUSSION The cornerstone of management of disseminated intravascular coagulation is treatment of the underlying condition. Unfortunately few effective therapeutic options are available in hormone refractory prostate cancer. However, the recent development of new active agents might reverse this situation. Recently a case of acute disseminated intravascular coagulation associated with hormone refractory prostate cancer was successfully treated with samarium 153.1 However, radiopharmaceutical treatment should be used with caution since a death related to the development of acute disseminated intravascular coagulation following administration of strontium 89 has been reported.2 Mitoxantrone chemotherapy has also been reported to be effective but normalization of blood tests requires at least 1 week.3 Since docetaxel is a promising drug in hormone refractory prostate cancer, we used a combination of docetaxel and cisplatin, which resulted in prompt resolution of the hematological disorders. The success of treatment was probably related to cytotoxic activity since reversal of hemostatic diathesis was associated with a decrease in serum PSA. Chemosensitivity might be related to a neuroendocrine component as suggested by increased serum NSE levels but in this case only classic adenocarcinoma cells were observed on liver biopsy. REFERENCES