Combination chemotherapy following adrenal suppression in androgen-independent prostate cancer

Objectives: Recent trials with modern chemotherapy have demonstrated activi ty in androgen-independent prostate cancer, but all focused on patients wit h progression following androgen suppression or antiandrogen withdrawal. Li mited data are available on the activity of chemotherapy in androgen-indepe ndent, hormone-refractory [progressing following adrenal suppression) prost ate cancer. We evaluated the activity of estramustine combined with vinblas tine in this subset of androgen-independent prostate cancer. Methods: from January 1995 until April 1999, 19 patients with hormone-refra ctory prostate cancer received estramustine 140 mg p.o., three times daily along with weekly vinblastine 5 mg/m(2) Results: A decrease in prostate-specific antigen of 50% or more was noted i n 12 patients (63.1%, 95% Cl 38.3-83.7%). The median decrease in prostate-s pecific antigen was 71.2% (range 50.5-85.2%). None of the 7 patients with m easurable soft-tissue disease showed an objective response. The median surv ival from onset of chemotherapy was 6 (range 1.4-27.7) months and from init iation of adrenal suppression 16.9 (range 3.8-40.5) months. Conclusions: The combination of estramustine and vinblastine is capable of inducing activity in androgen-independent prostate cancer progressing after adrenal suppression. In our small sample, the survival rate was low, and w e obtained no response in soft-tissue sites. Future prospective trials are needed to determine the benefit of sequential versus simultaneous incorpora tion of adrenal suppression with chemotherapy in the management of androgen -independent prostate cancer. Copyright (C) 2000 S. Karger AG. Basel.