Dexamethasone does not significantly contribute to the response rate of docetaxel and estramustine in androgen independent prostate cancer

• Published in: The Journal of urology Vol. 163; no. 3; p. 834
• Main Authors: Weitzman, A L, Shelton, G, Zuech, N, Owen, C E, Judge, T, Benson, M, Sawczuk, I, Katz, A, Olsson, C A, Bagiella, E, Pfaff, C, Newhouse, J H, Petrylak, D P
• Format: Journal Article
• Language: English
• Published: United States 01-03-2000
• Subjects: Adenocarcinoma - blood; Aged; Antineoplastic Agents, Hormonal - therapeutic use; Antineoplastic Agents, Phytogenic - therapeutic use; Dexamethasone - administration & dosage; Drug Administration Schedule; Estramustine - therapeutic use; Humans; Male; Paclitaxel - analogs & derivatives; Paclitaxel - therapeutic use; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - drug therapy; Taxoids
• ISSN: 0022-5347
• DOI: 10.1016/S0022-5347(05)67815-9

We evaluated the independent response rate of dexamethasone before docetaxel and estramustine administration as measured by changes in serum prostate specific antigen (PSA) in patients with androgen independent prostate cancer.
A total of 12 patients received 20 mg. dexamethasone orally every 6 hours for 3 doses repeated every 3 weeks before starting cytotoxic therapy with estramustine and docetaxel. After progression on dexamethasone 280 mg. estramustine orally 3 times daily on days 1 to 5 and 70 mg./m.2 docetaxel intravenously for 1 hour on day 2 were given.
None of the patients initially treated with dexamethasone monotherapy (median 1 cycle, range 1 to 5) had a PSA decline of 50% or greater. Median PSA increase on monotherapy was 47% (range 0% to 22%). On estramustine and docetaxel therapy PSA decreased 50% or greater in 11 patients (92%, 95% confidence intervals [CI] 60 to 99) and 80% or greater in 7 (58%, 95% CI 29 to 84), and normalized in 5 (42%, 95% CI 16 to 71), with a median duration of response of 153 (range 42 to 371), 132 (range 84 to 287) and 84 (range 21 to 174) days, respectively. Median times to reach 50% and 80% decreases in baseline PSA were 21 (range 21 to 209) and 63 (range 21 to 138) days, respectively. In 9 patients (75%, 95% CI 43 to 93) PSA decreased at least 50% by week 9. Of 4 patients with bidimensionally measurable disease 3 had a partial response. Median time to progression was 263 days (range 91 to 378).
Administration of 20. mg. dexamethasone orally every 6 hours for 3 doses every 3 weeks does not significantly contribute to the PSA response rate of estramustine and docetaxel.