Paclitaxel, estramustine phosphate, and carboplatin in patients with advanced prostate cancer.
OBJECTIVE
To determine the safety and activity of weekly paclitaxel in combination with estramustine and carboplatin (TEC) in patients with advanced prostate cancer.


METHODS
In a dose-escalation study, patients with advanced prostate cancer were administered paclitaxel (weekly 1-hour infusions of 60 to 100 mg/m(2)), oral estramustine (10 mg/kg), and carboplatin (area under the curve, 6 mg/mL-min every 4 weeks). Paclitaxel levels were determined 0, 30, 60, 90, and 120 minutes and 18 hours after infusion, and a concentration-time curve was estimated. Once a safe dose was established, a multi-institutional phase II trial was conducted in patients with progressive androgen-independent disease.


RESULTS
Fifty-six patients with progressive androgen-independent disease were treated for a median of four cycles. The dose of paclitaxel was escalated from 60 to 100 mg/m(2) without the occurrence of DLT. Posttherapy decreases in serum prostate-specific antigen levels of 50%, 80%, and 90% were seen in 67%, 48%, and 39% (95% confidence interval, 55% to 79%, 35% to 61%, 26% to 52%) of the patients, respectively. Of the 33 patients with measurable disease, two (6%) had a complete response and 13 (39%) had a partial response. The overall median time to progression was 21 weeks, and the median survival time for all patients was 19.9 months. Major grade 3 or 4 adverse effects were thromboembolic disease (in 25% of patients), hyperglycemia (in 38%), and hypophosphatemia (in 42%). Significant leukopenia, thrombocytopenia, and peripheral neuropathy were not observed.


CONCLUSIONS
TEC has significant antitumor activity and is well tolerated in patients with progressive androgen-independent prostate cancer.
Kelly
W K
WK
Genitourinary Oncology Service, Division of Solid Tumor, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021-6007, USA. kellyw@mskcc.org
Curley
T
T
Slovin
S
S
Heller
G
G
McCaffrey
J
J
Bajorin
D
D
Ciolino
A
A
Regan
K
K
Schwartz
M
M
Kantoff
P
P
George
D
D
Oh
W
W
Smith
M
M
Kaufman
D
D
Small
E J
EJ
Schwartz
L
L
Larson
S
S
Tong
W
W
Scher
H
H
D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004961:Estramustine / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009376:Neoplasms, Hormone-Dependent / Q000188:drug therapy; D017239:Paclitaxel / Q000008:administration & dosage; D017430:Prostate-Specific Antigen / Q000097:blood / Q000187:drug effects; D011471:Prostatic Neoplasms / Q000188:drug therapy*; D015996:Survival Rate
D004961:Estramustine; D016190:Carboplatin; D017430:Prostate-Specific Antigen; D017239:Paclitaxel