title: Combination chemotherapy with docetaxel, vinorelbine and estramustine phosphate in metastatic androgen-resistant prostate cancer: a single institution experience.
abstract: The aim of this study was to evaluate the activity and toxicity of docetaxel, vinorelbine and oral estramustine in androgen-resistant prostate cancer (ARPC).
  
  
  METHODS
  Fifty-two eligible patients were treated with docetaxel at 30 mg/m2 (day 1 and 8), vinorelbine at 20 mg/m2 (day 1 and 8), and oral estramustine of 280 mg p.o. (daily on days 1 to 7) every 3 weeks for 12 cycles. Patients with osseous metastases received zoledronic acid of 4 mg every 3 weeks. Low molecular weight heparin was administered on a prophylaxis basis to all patients.
  
  
  RESULTS
  A prostate-specific antigen (PSA) response > or = 50% from baseline was obtained in 29 (56%; 95% confidence interval [CI], 42-70%) patients. Objective responses among the 25 patients with measurable disease were observed in 48% (95% CI, 27-69%), including 1 patient with complete response (CR) and 11 patients with partial response (PR). Patients with extraosseous only, skeletal only, and extraosseous and skeletal metastases showed different PSA responses (87% vs. 44% vs. 59%, respectively, p = 0.094). Furthermore, patients with soft tissue disease only showed insignificantly better PSA response than those with skeletal metastases (response rate: 87% vs. 50%, p = 0.064). The median progression-free survival was 7.6 months (95% CI, 6.7-8.4 months) and the median overall survival was 18.2 months (95% CI, 15.5-20.8 months). The only parameters which were found to have an impact on survival were the extent of disease and the baseline levels of PSA. Toxicity was generally mild except for myelotoxicity. Neutropenia grade 3/4 was recorded in 33% of patients and 6% experienced febrile neutropenia. Anemia and thrombocytopenia grade 3 or 4 were not a problem. Three patients (6%) developed grade 3 sensory neuropathy and 2 patients (4%) developed grade 3 fatigue. Edema grade 3 occurred in 1 (2%) patient and thromboembolism grade 3 occurred in 2 (4%) patients.
  
  
  CONCLUSIONS
  The combination of docetaxel, vinorelbine and oral estramustine is a well-tolerated regimen with high biochemical and objective response rates in patients with ARPC.
authors.affiliation: Second Department of Internal Medicine, Propaedeutic, Oncology Section, University of Athens, Attikon University Hospital, Haidari, Athens, Greece. pectasid@otenet.gr
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Pectasides
authors.forename: Eirini
authors.initials: E
authors.lastname: Pectasides
authors.forename: George
authors.initials: G
authors.lastname: Papaxoinis
authors.forename: Anna
authors.initials: A
authors.lastname: Koumarianou
authors.forename: Amanda
authors.initials: A
authors.lastname: Psyrri
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Xiros
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tountas
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kamposioras
authors.forename: George
authors.initials: G
authors.lastname: Papatsibas
authors.forename: Theofanis
authors.initials: T
authors.lastname: Floros
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Gouveris
authors.forename: Sofia
authors.initials: S
authors.lastname: Karageorgopoulou
authors.forename: Theofanis
authors.initials: T
authors.lastname: Economopoulos