Estramustine phosphate sodium (
estramustine phosphate), a unique antitumour agent, is selectively taken up by prostate cells and exerts
antineoplastic effects by interfering with microtubule of dynamics and by reducing plasma levels of
testosterone. In noncomparative studies of
estramustine phosphate in patients with
hormone-refractory disease, objective response rates ranging from 19 to 69% have been reported. Preliminary clinical investigations indicate that combining
estramustine phosphate with
vinblastine,
etoposide or
paclitaxel improves objective response rates over single-agent treatment, although no survival benefit over single-agent treatment has been demonstrated to date. In comparative studies,
estramustine phosphate produces similar objective response rates to conventional
antineoplastic agents in patients with
hormone-refractory
prostate cancer. In previously untreated patients with advanced metastatic
hormone-responsive
prostate cancer, objective responses are achieved in approximately 80% of patients.
Estramustine phosphate appears to be at least as effective as
estrogen or
flutamide therapy in these patients.
Nausea and
vomiting are the most frequently observed adverse effects of treatment with
estramustine phosphate. While these symptoms are usually mild to moderate in nature, they may occasionally be more troublesome to the patient and necessitate withdrawal of treatment. Cardiovascular complications are a more serious, though less frequently encountered, adverse effect of the
drug. However, these complications may be avoided by careful patient selection and prophylactic treatment measures. Unlike some other
antineoplastic agents,
estramustine phosphate is rarely associated with myelosuppression. In addition to producing similar objective response rates to other established agents,
estramustine phosphate improves the subjective status of many patients and has been shown to reduce the intensity of
pain and improve the performance status of patients.(ABSTRACT TRUNCATED AT 250 WORDS)