Liposomal doxorubicin (Caelyx) in symptomatic androgen-independent prostate cancer (AIPC)--delayed response and flare phenomenon should be considered.
BACKGROUND
Compared with the native drug, liposomal PEG-coated doxorubicin (Caelyx) enhances tumour activity and reduces toxicity. The formulation may therefore be beneficial in anthracycline-sensitive malignancies, where toxicity represents a major problem, as is the case in androgen-insensitive prostate cancer (AIPC).


METHODS
In a multi-centre design 28 patients with advanced AIPC received Caelyx 40 mg/m2 as a 1-hour infusion every month. PSA-based biochemical and subjective response was recorded.


RESULTS
Three patients had biochemical responses, a subjective response was recorded in a fourth patient. No Grade 4 toxicity was encountered. Three patients developed a spontaneously recovering plantar-palmar erythema. In 3 of the 4 responding patients, the nadir PSA value was noted after 12 and 16 weeks, respectively. A possible flare phenomenon for PSA was evident in 4 patients.


CONCLUSIONS
Caelyx has limited activity in advanced AIPC. Due to its low toxicity profile the drug may be a worthwhile component of combination treatment of this chemotherapy-resistant condition. In general, clinicians should be aware of possible delay in PSA response as well as possible flare phenomenon during investigational systemic treatment of AIPC. Furthermore, standardization of blood sampling and PSA analyses are necessary in future therapeutic trials of AIPC.
Fosså
Sophie D
SD
Department of Medical Oncology and Radiotherapy, The Norwegian Radium Hospital, Montebello, Oslo. s.d.fossa@klinmed.uio.no
Vaage
Sigmund
S
Letocha
Henry
H
Iversen
Jon
J
Risberg
Terje
T
Johannessen
Dag C
DC
Paus
Elisabeth
E
Smedsrud
Trond
T
D000368:Aged; D000728:Androgens; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D004317:Doxorubicin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D009376:Neoplasms, Hormone-Dependent / Q000188:drug therapy*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy*
D000728:Androgens; D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal; D008081:Liposomes; D004317:Doxorubicin; D017430:Prostate-Specific Antigen