A reevaluation of nonhormonal cytotoxic chemotherapy in the treatment of prostatic carcinoma.

摘要: The palliative role of nonhormonal cytotoxic chemotherapy in the treatment endocrine-resistant prostatic carcinoma has not been established. Conventional means quantifying tumor response are most frequently applicable this disease because lack measurable objective parameters to allow for a reliable estimation antitumor effects. While problem is unique carcinoma, review illustrates its magnitude disease. Only approximately 5% patients studied fulfill various criteria complete (CR), partial (PR), or both, while vast majority reported as responders actually stable category. Stable highly questionable an indicator and should be used criterion conventional phase II studies unless it convincingly demonstrated that occurs result treatment. A study design may more assessment value category described text. More effective assessing responses better instruments measure aspects quality life needed. Review several prospective randomized clinical trials showed no program tested during last decade resulted survival advantage when compared with concurrently treated control group. Furthermore, two such trials, four different single chemotherapeutic agents widely (cyclophosphamide, 5-fluorouracil, estramustine phosphate, streptozocin) either alone combination, did produce any prolongation (standard treatment) arm. Survival curves fall within relatively narrow possibly predictable range additional endpoint conjunction (CRs PRs only) trials. definitive evidence therapeutic efficacy derive from III using one major endpoints. Because poor results observed thus far, we suggest appropriate arm testing continues consisting best symptomatic care uniformly applied second-line endocrine manipulation.