A phase II study investigating the re-induction of endocrine sensitivity following chemotherapy in androgen-independent prostate cancer.
When chemotherapy is used in androgen-independent prostate cancer (AIPC), androgen deprivation is continued despite its failure. In this study, we investigated whether it was possible to re-induce hormone sensitivity in previously castrate patients by stopping endocrine therapy during chemotherapy. A phase II prospective study investigated the effects of reintroduction of endocrine therapy after oral chemotherapy in 56 patients with AIPC, which was given without concurrent androgen deprivation. After chemotherapy, patients were given maximum androgen blockade until failure when treatment was switched to diethylstilbestrol and dexamethasone. Patients had already received these endocrine treatments in the same sequence before chemotherapy. All patients were castrate at the start of chemotherapy. Forty-three subsequently restarted endocrine therapy after the completion of chemotherapy. The median overall survival for these 43 patients from the time of restarting endocrine therapy was 7.7 months (95% confidence interval (CI): 3.7-10.9 months). Sixteen (37%) patients had a 50% PSA response to treatment, which was associated with improved overall survival (14.0 months vs 3.7 months P=0.003). Eight out of 12 patients who did not respond to diethylstilbestrol before chemotherapy did so post chemotherapy. Re-induction of hormone sensitivity can occur after chemotherapy in AIPC.
Shamash
J
J
Department of Medical Oncology, St Bartholomew's Hospital, London, UK. jonathan.shamash@bartsandthelondon.nhs.uk
Davies
A
A
Ansell
W
W
Mcfaul
S
S
Wilson
P
P
Oliver
T
T
Powles
T
T
D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D002369:Castration; D003907:Dexamethasone / Q000627:therapeutic use*; D004054:Diethylstilbestrol / Q000627:therapeutic use*; D004968:Estrogens, Non-Steroidal / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009376:Neoplasms, Hormone-Dependent / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate
D018931:Antineoplastic Agents, Hormonal; D004968:Estrogens, Non-Steroidal; D004054:Diethylstilbestrol; D003907:Dexamethasone; D017430:Prostate-Specific Antigen