Cis-diamminedichloroplatinumによる尿路性器癌の化学療法

Abstract

Twenty three patients with advanced genito-urinary carcinoma were treated with cis-diamminedichloroplatinum, including 6 patients with testis tumor, 7 with urothelial tumor, 6 with prostatic cancer and 4 with renal cell carcinoma. Twenty-one of them were given also bleomycin and vinka alkaloid. To synchronize the tumor cell cycle, sequency of the treatment was carried out with the combined method of Barranco et al. and Vadlamudi et al. In brief, bleomycin was initially given intramuscularly with the dosis of 2.5 mg X 4/day (q 6 hrs) for 3 consequtive days in testis tumor patients and 5 mg/day for 7 consequtive days in other tumor patients. On Day 4 and 5 in the former (or 8 and 9 in the latter) vinka alkaloid (5-10 mg of vinblastine or 1-1.5 mg of vincristine) was given intravenously by one push and on Day 6 (or 10) 60 mg/m2 of cis-diamminedichloroplatinum was administered by slow infusion with mannitol diuresis. The regimen was repeated every three weeks, if no serious side effects were recognized. All of 6 patients with testicular tumor showed objective remissions, 4 complete and 2 partial, a 100% response rate. Three of seven patients (43%) with urothelial tumor showed partial remissions. Whereas, among 6 patients with estrogen registant prostatic cancer, there was only one partial remission and in 4 patients with renal cell carcinoma no responses were seen. However, in prostatic cancer patients, severe pain due to bone metastases was markedly reduced and in this meaning, the present combination chemotherapy seemed to be clinically useful for these patients. Renal dysfunction occurred in 5 patients, including one with marked drop of creatinine clearance rate in consequent use of aminoglycoside for the penicillin registant septicemia. Bone marrow dysfunction was inevitable when vinblastine had been given as vinka alkaloid. Leucopenia less than 2, 000/mm[3] was seen in 11 patients and thrombocytopenia less than 100, 000/mm3 in 6. Vincristine, when given instead of vinblastine, caused no serious myelosuppression. This combination of agents appears to be active in testicular and urothelial tumor and it may be of value in prostatic cancer.