Preliminary results of mitoxantrone and hydrocortisone in the treatment of hormone
refractory prostate cancer
Article published in Urologia Polska 2002/55/3.
Paweł Wiechno, Beata Paluchowska, Piotr Marczyński, Tomasz Demkow
- Klinika Nowotworów Układu Moczowego Centrum Onkologii-Instytutu w Warszawie
Kierownik kliniki: dr hab. Tomasz Demkow
prostate, cancer, hormone refractory prostate cancer, chemotheraphy, mitoxantrone
- The aim of the study; We present preliminary results of mitoxantrone and hydrocortisone in the treatment of hormone refractory prostate cancer.
- Material and method. Between March 15.2000 and August 30,2001, in the Clinic of Genitourinary Tract Neoplasms, 15 patients aged from 46 to 78 years (mean 65 years) with advanced hormone refractory prostate cancer and in good general status were qualified to the treatment with hydrocortisone (40 mg/day, orally) combined with mitoxantrone (12 mg/m2 intravenously, every 21 days). PSA levels before cytostatic treatment introduction were from 25 ng/ml to 3633 ng/ml (mean: 189 ng/ml). In 12 patients metastases to the skeleton were diagnosed; 3 of them had also soft tissue metastases. In 3 patients increase of the PSA level was a single sign of cancer progression. In 9 patients progression of the disease was associated with subjective symptoms and signs. Toxicity of the treatment, subjective and radiologic responses, PSA levels and time to cancer progression were estimated.
- Results. Patients obtained from 3 to 9 cycles of (he treatment (mean 7 cycles); in totally 95 cycles. In 10 patients the cytostatic treatment was stopped due to cancer progression, in 3 patients is still being continued. Three patients died, \'lire most frequent adverse events were: thrombocytopenia, leukopenia and anaemia. Supraventricular arrhythmia or thrombophlebitis were rare. In 7 oI9 patients subjective improvement was noted. In 12 patients PSA level decreased; in 6 of them decreased levels were satisfied to partial response criteria. In 2 of 12 patients decrease of osseous metastases, and in 1 of 3 patients a decrease of soft tissue metastases was observed. Progression of the disease was noted from 9 to 27 weeks (mean 21 weeks) after the start of the therapy. Conclusions. In patients with hormone refractory prostate cancer and castration testosterone levels, the treatment with hydrocortisone and mitoxantrone is well tolerated, in about 40% of patients objective response is observed, and in majority of patients subjective improvement is noted.
- 1. Crawford ED, Eisenberger MA, McLeod GD: A controlled trial ofleuprolide with and without flutamide in prostatic carcinoma. N Eng J Med 1989; 321:419-24.
- 2. Stone AR, Hargreave TB, Chisholm GD: The diagnosis of oestrogen escape and the role of secondary orchidectomy in prostate cancer. B J Urol 1980; 52:535-8.
- 3. Kantoff PW, Halabi S, Conaway M i wsp: Hydrocortisone with or without mitoxantrone in men with hormone - refractory prostate cancer: results of the cancer and leukemia group B 9182 study. J Clin Oncol 1999; 17 (8):2506-13.
- 4. Dowling A), Czaykowski PM, Krahn MD I wsp: Pivstate specific antigen response to mitoxantmne and prednisone in patients with refracloiy prostate cancer: prognostic factors and generalizabi-lity of a multicenter trial to clinical practice. J Urol 2000; 163 (5): 1481-5.
- 5. Horwich A Waxman J, Schroeder F:Turnouts of the prostate, w: Oxford Textbook of Oncology, t. 2, Oxford University Press 1995; 1498-1530.
- 6. Picus J, Schultz M: Docetaxel (Taxotere) as monotherapy in the treatment of hormone - refractory prostate cancer: preliminaiy results. Semin Oncol 1999; 26 (5 Suplement 17):14-18.
- 7. Sumiyoschi Y, Hashine K, Nakalsuzi li I wsp: Oral estramustine phosphate and oral etoposide for the treatment ofhomtone - zefactory prostate cancer. In J Urol 2000; 7 (7): 243-7.
- 8. Wcitzman AL, Shelton G, Zuech N I wsp: Dexamethasone does not significantly contribute to the response rale of docetaxel and estramustine in androgen independent prostate cancer. J Urol 2000; 163 (3): 834-7.
- 9. Savarese DM, Halabi S, Akerley WLI wsp: Phase II study of docetaxel, estramustine and low-dose hydrocortisone in men with hormone-refractory prostate cancer: a final report ofCALGB 9780. J Clin Oncol 2001; 19 (9): 2509-16.
- 10. Nishimura K, Nonomura N, Ono YI wsp: Oral combination of cyclophosphamide, uracil plus tegafurand estramustine for hormone - refractory pmstate cancer. Oncology 2001; 60 (1):49-54.
- 11. Bracarda S, \\\'lbnato M, Rosi PI wsp:Oral estramustine and cyclophosphamide inpatients with metastatic hormone refractory prostate carcinoma: a phase II study. Cancer 2000; 88 (6): 1438-44.
- 12. Munshi HG, Pienia KJ, Smith DC:Chemotherapy in patients with pmstate specific antigen - only disease after ptimaiy therapy for prostate carcinoma:a phase II trial of oral estramustine and oral etoposide. Cancer 2001; 91 (11): 2175-80.
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