前立腺癌に対する化学療法

Abstract

前立腺癌の治療成績の向上には前立腺癌の早期発見・早期根治治療に努めるとともに, 進行癌とくに低分化型腺癌に対する治療の開発が必要である.CDDPを中心とする化学療法ではPRが20/59例にみられたが, 生存率の改善はえられず, 進行前立腺癌に対するCDDPを中心とした化学療法はいまだその有用性は認められていない.しかし抗男性ホルモン療法に抵抗を示す進行前立腺癌の治療に他の有効な治療法が見いだせない現状では, 今後前立腺癌の自然史の解明と分子生物学的領域からもさらに有効な抗癌剤の開発や治療方法の向上に努力すべきである

CDDP combined chemotherapy was performed in 55 cases out of 229 prostatic cancer patients who were treated in Nara Medical University and Nara Prefectural Nara Hospital between January 1979 and August 1989. The previously untreated 33 patients received chemotherapy with anti-androgen treatment as an initial treatment, as well as 7 cases of unresponsive to antiandrogen treatment, 14 relapsing cases and one case with recurrence after total prostatectomy. The major regimens of chemotherapy were cis-diammine dichloroplatinum (CDDP) alone in 16 cases, PVB regimen (bleomycin or peplomycin + vincristine + CDDP) in 19 cases, and CAP regimen (cyclophosphamide + adriamycin + CDDP) in 16 cases. Complete response was not achieved or partial response was observed in 20 cases (34%), no change was seen in 20 cases (34%), and progression was seen in 19 cases (32%). Among each evaluable lesion, effects (CR + PR) were observed in 40% in the prostate, in 18% in the bone lesions, in 44% in the soft tissue lesions, and in 42% in the prostatic tumor marker. The 7-year survival rate of the chemotherapy group (35.6%) was better than that of the antiandrogen treatment group (26.6%) in stage D patients, but was not significant statistically When evaluated by the regimen, a partial response was observed in 56% of CDDP alone, in 21% of PVB regimen, and in 38% of the CAP regimen. However, there was no significant difference in survival rate among the regimens. As an adverse effect, myelosuppression and renal toxicity seemed to be dose limiting factors of CDDP combined chemotherapy for advanced prostatic cancer patients.