Estramustine Improves Prostate Cancer Survival

However, drug associated with thromboembolic events in patients with castration-refractory prostate cancer

FRIDAY, Oct. 19 (HealthDay News) -- Adding estramustine to chemotherapy can significantly improve overall survival for patients with castration-refractory prostate cancer, according to a meta-analysis published in the November issue of The Lancet Oncology.

Karim Fizazi, M.D., Ph.D., of the Institut Gustave Roussy in Villejuif, France, and colleagues analyzed data from five trials that included 605 patients. The patients were randomly assigned to chemotherapy -- consisting of docetaxel, paclitaxel, ixabepilone or vinblastine -- or chemotherapy with estramustine, which is a nornitrogen mustard-estradiol conjugate that inhibits microtubule function. Median follow-up was 2.8 years.

The researchers found that overall survival was improved in patients treated with estramustine (adjusted hazard ratio 0.77). Patients on estramustine also had a better prostate-specific antigen (PSA) response (relative risk 0.53) and significantly longer time to PSA progression (hazard ratio 0.74). However, patients on estramustine had a significantly increased risk of grade 3 or grade 4 thromboembolic events (RR, 4.51).

"Since treatment with chemotherapy plus estramustine showed increased anti-tumor activity…this combination as first-line treatment of patients with castration-refractory prostate cancer would seem logical and reasonable, at least in those patients with no major thromboembolic risks and with or without thrombo-prophylaxis," the authors write.

One of the study authors, William R. Berry, is a member of the Sanofi-Aventis speakers bureau.

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