Prospective evaluation of hydrocortisone and suramin in patients with androgen-independent prostate cancer.
OBJECTIVE
To assess efficacy of intermittent infusion of suramin in patients with androgen-independent prostate cancer who have had disease progression on hydrocortisone.


METHODS
Chemotherapy-naive patients with progressive androgen-independent prostate cancer were given hydrocortisone 40 mg/d and monitored for treatment effect. At the time of disease progression, suramin was administered on a pharmacokinetically derived, 2-week dosing schedule.


RESULTS
Thirty patients with a median Karnofsky performance status (KPS) of 90% were treated with hydrocortisone. No responses were seen in 12 patients with measurable disease or 29 patients with abnormal bone scans. Thirty patients had an increasing prostate-specific antigen (PSA) level before treatment and six (20%) had a more than 50% decline in PSA from the baseline value for a median of 16 weeks (range, 12 to 52+). Twenty-eight patients had disease progression after a median of 7 weeks (range, 3 to 23), and two patients have continued to receive hydrocortisone for 44 and 52 weeks. Twenty-eight patients received hydrocortisone and suramin, with median suramin concentrations of 97 to 170 micrograms/mL for 4 weeks. No responses in measurable disease and no improvements in bone scans were seen. Five patients (18%) showed a more than 50% decline in PSA levels from baseline, of whom three had previously responded to hydrocortisone. Only two of 24 patients who did not show a posttherapy decline in PSA levels after hydrocortisone had a reduction in PSA levels with the addition of suramin. Toxicity profiles were acceptable with each agent, although a higher proportion of subjects showed hematologic, cardiac, and neurologic events when suramin was added.


CONCLUSIONS
Suramin has limited efficacy in patients with androgen-independent prostate cancer who have had disease progression after hydrocortisone.
Kelly
W K
WK
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Curley
T
T
Leibretz
C
C
Dnistrian
A
A
Schwartz
M
M
Scher
H I
HI
D000368:Aged; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D012074:Remission Induction; D013498:Suramin / Q000008:administration & dosage* / Q000493:pharmacokinetics; D013739:Testosterone / Q000378:metabolism*
D013739:Testosterone; D013498:Suramin; D017430:Prostate-Specific Antigen; D006854:Hydrocortisone