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Chemotherapy of hormonally unresponsive prostatic carcinoma.

The national Prostatic Cancer Project has evaluated single and combination chemotherapeutic agents for the treatment of patients with advanced prostatic cancer that has been unresponsive to hormonal therapy. Although regression rates have been modest, a number of drugs have shown some efficacy and are now undergoing testing in combination. Current trials of the LH-RH agonists and the antiandrogen flutamide are in progress. These trials have demonstrated a role for chemotherapy in the treatment of the patient who has failed hormonal therapy.

Antineoplastic Agents↗

[Cytostatic therapy of prostatic carcinoma. Current status and personal results].

Based on the pertinent literature, this paper discusses the results of cytostatic therapy for advanced prostatic cancer published so far with special consideration given to the extensive experience of the National Prostatic Cancer Project (NPCP) in the United States. Endoxan and 5-Fluoro-uracil, each as a monotherapy, haven proven still to be the optimal cytostatic therapies in secondary treatment following hormone resistance. Moreover, our own results reached with 33 patients on chemotherapy with Endoxan or 5-Fluoro-uracil, resp., are reported, in particular those in 24 of the 33 patients receiving these drugs as a third therapy after previous hormone resistance and secondary Estracyt resistance. Especially with regard to pain relief, we obtained good results in 50% of cases. The average survival period of the patients on third therapy was 6.7 months. Side effects prevailed in the gastrointestinal tract and the hemopoetic system. The results with Endoxan and 5-Fluoro-uracil as primary therapies have thus far been unsatisfactory with regard to therapy response and drug tolerance.

Aged↗

Estracyt--clinical experiences.

Since the introduction of estrogen treatment of prostatic carcinoma in 1941 this treatment has been considered the treatment of choice until recently, when both conventional cytotoxic compounds and hormone cytotoxic agents have been used. Preliminary results are in many aspects very promising (Jönsson, Högberg & Nilsson, 1977). However, controlled randomized series are badly needed to give a final answer how to proceed. So far chemotherapy has been given only for palliation but new approaches and combined treatment modalities might point forward to a treatment that, hopefully, will cure prostatic carcinoma especially if the treatment is started in the very early stages.

Estramustine↗

EORTC protocols in prostatic cancer. An interim report.

Two parallel prospective randomized studies have been undertaken by the EORTC Urological Group in previously untreated patients with prostatic cancer in order to compare low dose Stilboestrol versus Cyproterone acetate versus Medroxyprogesterone acetate in the first trial, and Stilboestrol versus Estracyt in the second trial. Although the follow up is still short, no superiority of the other drugs over Stilboestrol had appeared so far with regard to either objective response or significant side effects apart from gynaecomastia. In the third trial, patients with advanced disease no longer responsive to hormonal treatment were randomized to either Adriamycin or Procarbazine. Toxicity and early death were particularly frequent in Procarbazine treated patients, whereas most patients progressed in both treatment groups.

Cyproterone↗

[Treatment of advanced metastasizing carcinoma of the prostate with estracyt (author's transl)].

We treated 41 patients with advancing metastatic carcinoma of the prostate in our hospital for 21 days by giving 2 X 150 mg Estracyt intravenously per day. We saw good clinical results in 32 of the 41 patients (= 78%). We found a statistically significant (P less than 0.05) decrease of the acid and prostatic phosphatases. There was a significant (P less than 0.05) increase of the alkaline phosphatases. We did not see any renal or hematologic toxicity. Ten % of our intravenously treated patients experienced thrombophlebitis at the site of injection. Estracyt showed good clinical results.

Acid Phosphatase↗