TREATMENT OF ADVANCED HORMONE-REFRACTORY PROSTATE CARCINOMA WITH A COMBINATION OF ETOPOSIDE, PIRARUBICIN AND CISPLATIN

A total of 20 patients with hormone-refractory prostate carcinoma ente red a pilot study of combination chemotherapy based on the EAP (etopos ide, Adriamycin and cisplatin) regimen, in which Adriamycin was replac ed by pirarubicin, a less cardiotoxic derivative of Adriamycin. The re sponse was assessed by criteria modified from those of the National Pr ostatic Cancer Project: prostate-specific antigen was employed instead of acid phosphatase. Of 18 evaluable patients, 6 achieved a partial r esponse, 5 had stable disease, and in 7 the disease had progressed dur ing therapy; thus, the overall response rate was 33.3% [95% confidence interval (CI) 11.5-55.1%]. Significant pain alleviation and performan ce status improvement were obtained in 5 of 12 patients (41.7%; CI 13. 8-69.6%) and 3 of 13 patients (23.1%; CI 0.2-46.0%), respectively. Alt hough myelosuppression was moderate to severe, no chemotherapy-related deaths or bacteriologically documented sepsis occurred; nor was there any clinical cardiotoxicity. All the responding patients received mai ntenance chemotherapy with etoposide thereafter. At present, the media n duration of response is 33 weeks (range: 23-91 weeks) and the median survival period for all patients is 42 weeks (range: 27+-136 weeks), with 12 deaths. In spite of the small number of patients treated, thes e results suggest that this chemotherapy regimen is active in advanced hormone-refractory prostate carcinoma.