多西他赛加泼尼松耐药的前列腺癌联合雌二醇氮芥治疗22例报告

摘要

Objective To investigate the efficacy and safety of Estramustine/Prednisone/ Docetaxel combination (E/P/D) as salvage chemotherapy for patients with metastatic castration-resistant prostate cancer (mCRPC) after the failure of Prednisone/Docetaxel (P/D). Methods 22 CRPC patients for whom P/D treatment had failed received E/P/ D combination between November 2005 to June 2009. A decrease of >50% in PSA was set as the primary endpoint. The toxicity profiles were also reviewed. Rusults Patients received a total of 94 cycles of E/P/D treatment. 64% patients had treatment response. The median biochemical progression-free survival was 17.1 weeks, and the median overall survival was 54.3 weeks. Despite grade 3-4 neutropenia in 36% of patients, this combination was in general tolerable. Conclusion Estramustine/Prednisone/Docetaxel combination is relatively active with acceptable toxicity profile as salvage treatment for mCRPC patients after the failure of P/D.%目的 观察对多西他赛加泼尼松方案耐药的去势抵抗性前列腺癌(Castration-Resistant Prostate Cancer,CRPC)病例联合应用雌二醉氮芥的疗效和安全性.方法 CRPC患者22例在多西他赛加泼尼松治疗过程中病情进展(血PSA升高)时,用雌二醇氮芥联合多西他赛及泼尼松方案二线治疗:多西他赛75mg/m2,第1天,泼尼松5 mg bid,第1天起连续应用,雌二醉氮芥280mg bid,第1天起连用5d.21d为1周期.主要观察终点是PSA,PSA下降＞50%为有效.次要观察终点包括生化无进展生存期、总生存期、客观有效率及毒副作用.结果 22例患者共完成94个周期.有效14例,有效率64%.中位生化无进展生存期17.1周,中位总生存期54.3周.Ⅲ-Ⅳ度毒副作用包括心脏毒性1例(5%),中性粒细胞减少8例(36%),粒细胞缺乏性发热1例(5%).2例因毒副作用退出治疗.结论 雌二醇氮芥联合多西他赛及泼尼松二线治疗多西他赛加拨尼松方案耐药的CRPC患者疗效较好,毒副反应可以耐受,值得进一步观察研究.