再燃前立腺癌に対するEstramustine,Etoposide併用間歇経口内分泌化学療法

Abstract

1998年12月～2001年6月までに本治療を開始した10病院の17例(64～88歳, 平均72歳)について検討を行った.全例組織学的に前立腺癌と診断され, 内分泌療法を行った後に再燃をきたした再燃前立腺癌患者であった.estramustin6mg/kg/dayとetoposide30mg/m2/dayを分2で経口投与とした.初回治療前のPSA値は9.3～5000ng/mlで, 本治療開始時のPSAは9.1～545.7ng/ml, 全289サイクルを施行した.この17例の中PSAの変化が測定されPSAによる効果判定が可能であったものは15例であった.服薬方法の理解は全症例で良好であり, 誤用例は1例もなかった.治療効果はCR2例, PR5例, NC6例, PD2例であった.responder, non-responderの背景因子を検討したが, 年齢, 最初のPSA値, 再燃までの期間, 投与前のPSA値, 投与後のPSA最低値, 生存期間とは無関係であった.有害事象については, 17例中5例で食欲低下や嘔気が出現したが, grade 2以上を示したものはなく点滴や入院を要した症例もなかった

Seventeen patients were given lower dose and intermittent oral administration of estramustine phosphate (6 mg/kg/day) and etoposide (30 mg/m2/day) for 7 days. Then administration was discontinued for 7 days. This administration cycle was repeated. Therapy was continued until evidence of disease progression or unacceptable toxicity occurred. Fifteen of the 17 patients were finally evaluated for PSA response. Overall, the pretreatment PSA levels were lowered at least 50% from baseline in 7 (47%) of the 15 patients. The median survival was 65 weeks. Five of the 17 patients complained of anorexia or nausea during the treatment, but none of them showed over grade 2 anorexia, none requiring transfusion or hospitalization. None of the patients showed edema, deep venous thrombosis, thrombocytopenia, anemia or myocardial infarction. Because of its rare and mild adverse effects, this intermittent administration of oral estramustine and oral etoposide may be a useful and secure regimen for hormone refractory prostate cancer.