前立腺癌に対するLH-RHアナログ療法における酢酸クロルマジノン先行投与の有用性

Abstract

未治療前立腺癌(stage B～D)44例に対し, 酢酸クロルマジノン(CMA)を4週間(I群), 或いは2週間(II群)の先行投与後にluteinizing hormone-releasing hormone(LH-RH)アナログを併用し, 一過性のT上昇の予防効果ならびに近接効果について検討した. 1)12週後効果判定の奏効率はI群83.3%, II群93.8%で, 2群間に有意差を認めなかった. 2)LH, testosterone(T)はLH-RHアナログ初回投与3日後に2群とも有意の上昇を認めたが, 治療前値よりは低値であった.PSAは2群共に有意の上昇は認めず, stage C, D症例においてflare-upと思われる症状の増悪もみられなかった.以上から, 2週間のCMA先行投与によるLH-RHアナログとCMAの併用療法により, 一過性のT上昇は十分予防できると考えられた

We evaluated the efficacy of pretreatment with chlormadinone acetate (CMA) in preventing the initial testosterone surge induced by luteinizing hormone-releasing hormone (LH-RH) analogue. A total of 44 patients with previously untreated prostate cancer was included in this study. Patients were randomly assigned to 2 treatment groups: Group I-CMA therapy was begun 4 weeks before the initial LH-RH analogue injection. Group II-CMA therapy was begun 2 weeks before the initial LH-RH analogue injection. After the initial LH-RH analogue injection, CMA was administered for 12 weeks or more. After LH-RH analogue application mean values of serum luteinizing hormone (LH) and testosterone increased in both groups on day 3. However, LH and testosterone levels remained below pretreatment values in both groups. CMA pretreatment reduced the mean serum PSA. The mean relative PSA level slightly increased after administration of the LH-RH analogue in group I on day 7. In group II, the mean relative PSA level decreased after LH-RH analogue administration. Objective response rates at 12 weeks were 83.3% and 93.8% in group I and group II. Our results indicate that pretreatment with CMA for 2 weeks appeared to be sufficient to prevent the initial testosterone surge induced by LH-RH analogue.