進行前立腺癌におけるLH-RHアナログ投与時のフレアアップに対する酢酸クロルマジノン先行・併用療法の効果

Abstract

臨床病期C・Dの前立腺癌にCMAを4週間先行投与し, その後LH-RHaとの併用療法を継続することによりフレアアップの予防が可能かどうかを検討した.1)CMAの4週間先行・併用療法ではLH-RHa投与直後のテストステロンの一過性上昇を防げなかったが, 正常範囲内の変動に抑えられた.2)LH-RHa併用から1週迄の間に20%以上のPSA上昇を認めたのは21例中3例で, 低分化2例・中分化1例であった.この低分化2例の24wでの効果判定はいずれもPDであった.3)LH-RHa併用に関連した臨床症状の増悪を認めた例は1例もなく, CMAの4週間先行・併用療法により病期C・D前立腺癌のフレアアップは予防できると考えられた

To investigate whether chlormadinone acetate (CMA) could prevent the flare-up phenomenon induced by a luteinizing hormone-releasing hormone analogue (LH-RHa), we treated 4 cases of stage C and 17 cases of stage D prostate cancer with CMA for 4 weeks and CMA plus monthly injection of LH-RHa for following 24 weeks. Serum LH, testosterone, and prostate-specific antigen (PSA) levels were closely monitored before and 3 days, 1-, 2-, and 4-weeks after LH-RHa injection. Subjective and objective responses were also investigated. Serum LH and testosterone levels significantly elevated 3 days after the initial injection of LH-RHa. However, they resumed 1 week after LH-RHa injection with fluctuation under the normal range. Out of 21 cases, 3 cases (14%) consisting of 2 poorly and 1 moderately differentiated adenocarcinoma showed increased serum PSA levels 1 week after LH-RHa injection in spite of suppressed serum testosterone levels. The objective response of these 2 poorly differentiated cases was progressive disease at 24 weeks. No cases indicated worsening of clinical symptoms concerning flare-up phenomenon. CMA seemed to be capable of preventing flare-up phenomenon in advanced prostate cancer.