前立腺癌に対するLH-RH analogue投与における酢酸クロルマジノン先行・併用療法の臨床的検討 : 脂質代謝への影響

Abstract

1)酢酸クロルマジノン(CMA)単独投与により血中LH, T, PSA, γ-Sm, PAPに著明な低下がみられた.LH, TはLH-RHa初回投与時と比べ3日後に有意に上昇したがCMA投与前値迄には復さなかった. 2)副腎性androgenとしてDHEA-Sを観察した.CMA単独投与により, 正常域下限まで有意に低下し, LH-RHa併用後もその値が継続した.しかし副腎機能不全はみられなかった. 3)併用12週後, 24週後のPSA効果判定は, PR以上が100%, 86.7%, 他覚所見総合評価では, PR以上が61.9%, 75.0%. 4)併用24週後の脂質の推移では, 投与前高値のTGが正常域まで有意に低下した.apoC-II, C-IIIに有意な低下がみられたが, その他のapolipoprotein, HDL-chol, LDL-chol, T-chol, LPO, Lp(a)には明らかな影響はみられなかった

Twenty-four previously untreated patients with a diagnosis of prostatic cancer were treated with chlormadinone acetate (CMA) alone (100 mg/day) for 4 weeks, and luteinizing hormone-releasing hormone analogue (LH-RHa) was added for the next 24 weeks. Marked decreases in blood LH, testosterone (T), prostate specific antigen (PSA), gamma-seminoprotein (gamma-Sm), and prostatic acid phosphatase (PAP) were observed after a single dose of CMA. T levels were significantly increased 3 days after the initial dose of LH-RHa, and did not return to the pretreatment level. There were no significant increases in any of the markers, nor were there any flare-up cases. Triglyceride levels, which were slightly elevated before the start of treatment, were significantly decreased 24 weeks after the completion of combined therapy. PSA was evaluated as partial response (PR) or better in 86.7% of the patients. Overall evaluation showed PR or better in 75.0% of the patients. These findings suggest that prior administration of CMA followed by combined administration with LH-RHa is useful in the treatment of prostatic cancer. No negative effects on lipid metabolism were observed at any time during the treatment period.