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Long Term Use of Megestrol Acetate by Cancer Survivors for the Treatment of Hot Flashes
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BENIGN AND MALIGNANT NEOPLASMS OF PROSTATE
Effect of F’rednisone on Prostate-Specific Antigen in Patients With Hormone-Reffactory Prostate Cancer
0. SARTOR, M. WEINBERGER, A. MOORE,A. LI AND W. D. FIGG,Departments of Urology and Medicine, Louisiana State University Medical Center, Shreueport, Louisiana, and Medicine Branch, National Cancer Institute, Bethesda, Maryland Urology, 5 2 252-256, 1998 Objectives. To evaluate the effects of prednisone on prostate-specific antigen (PSA) in a cohort of patients with “hormone-refractory” prostate cancer. Methods. Data were collected from 29 consecutive patients with hormone-refractory progressive prostate cancer who were treated with 10 mg of prednisone orally two times a day. Patients were included in this analysis only if other factors known to influence PSA levels (antiandrogen withdrawal, radiation, a n d o r other concomitant anticancer therapies) were definitively excluded as potentially confounding variables. Results. The mean and median PSA decline after initiating prednisone was 33%(95% confidence interval [CI] 2 0 9 to 46’1;) and 24‘1; (range 0% to 99’1;), respectively. Ten patients (34%) had a PSA decline of more than 5 0 9 and 4 patients (14’1;) had PSA declines of more than 75%. The average and median time for progression-free survivals were 2.8 (95% CI 1.7 to 3.8) and 2.0 (range 0 to 111months. Four (14%) patients had PSA declines lasting 6 months or more. Median survival was 12.8 months. Additional analyses indicated that a PSA decline of more than 50’1;, compared with less than 50%, was associated with a longer survival. Toxicities included steroid myopathy ( n = 4), new-onset diabetes ( n = l ) , and dyspnea ( n = 1). Conclusions. Prednisone (10 mg orally two times a day) can decrease PSA by more than 5 0 8 in approximately one third of patients with hormone-refractory progressive prostate cancer. On the basis of comparisons with other data sets, we hypothesize a dose-response relationship between glucocorticoid dose and PSA decline. Editorial Comment: Many patients in whom hormonal therapy fails are not candidates for aggressive attempts at chemotherapy. This study provides reasonable data on the expectation following treatment with prednisone. Patrick C. Walsh. M.D.
Long Term Use of Megestrol Acetate by Cancer Survivors for the Treatment of Hot Flashes
S. K. QUELLA, C. L. LOPRINZI, J. A. SLOAN, N. L. VAUGHT, W. L. DEKREY, T. FISCHER, G. FINCK,N. PIERSON AND T. PISANSKY,Mayo Clinic and Mayo Foundation, Rochester, Minnesota, Siouxland Hematology-Oncology Associates, Sioux City and Iowa Oncology Research Association CCOP, Des Moines, Iowa, Grand Forks Clinic, Ltd., Grand Forks, and Quain and Ramstad Clinic, Bismarck, North Dakota, and Sioux Community Cancer Consortium, Sioux Falls, South Dakota Cancer, 82: 1784-1788,1998 BACKGROUND. Hot flashes are often a troublesome symptom in breast carcinoma survivors and men with prostate carcinoma who have undergone androgen deprivation therapy. A previous clinical study demonstrated that, on a short term basis, low dose megestrol acetate markedly reduced hot flashes and was well tolerated. Little information has been available regarding the long term use of low dose megestrol acetate for hot flashes. METHODS. Patients previously enrolled on a randomized placebo-controlled trial that evaluated the short term use of megestrol acetate for hot flashes were contacted and interviewed by telephone. RESULTS. A total of 132 persons were contacted. Nine percent of the patients discontinued megestrol acetate after resolution of their hot flashes. Forty-five percent of the patients contacted were continuing to utilize megestrol acetate approximately 3 years beyond the conclusion of the 1992 study. Three-quarters of these patients were utilizing 5 2 0 mg of megestrol acetate per day. Potential toxicities attributed to megestrol acetate included episodes of chills, appetite stimulatiodweight gain, vaginal bleeding, and carpal tunnel syndrome symptoms. CONCLUSIONS. A substantial proportion of patients continue to use megestrol acetate for periods of up to 3 years or longer with continued control of hot flashes. This treatment appears to be relatively well tolerated. Editorial Comment: Many patients on hormone therapy have hot flashes. I have not routinely used megestrol but this study indicates that maybe I should. The authors evaluated patients who were in a clinical trial for 8 weeks. Surprisingly, at least to me, 45%of patients continued to use megestrol for approximately 3 years, which suggests that it must be working. Patrick C. Walsh, M.D.
BENIGN AND MALIGNANT NEOPLASMS OF PROSTATE
Effect of F’rednisone on Prostate-Specific Antigen in Patients With Hormone-Reffactory Prostate Cancer
0. SARTOR, M. WEINBERGER, A. MOORE,A. LI AND W. D. FIGG,Departments of Urology and Medicine, Louisiana State University Medical Center, Shreueport, Louisiana, and Medicine Branch, National Cancer Institute, Bethesda, Maryland Urology, 5 2 252-256, 1998 Objectives. To evaluate the effects of prednisone on prostate-specific antigen (PSA) in a cohort of patients with “hormone-refractory” prostate cancer. Methods. Data were collected from 29 consecutive patients with hormone-refractory progressive prostate cancer who were treated with 10 mg of prednisone orally two times a day. Patients were included in this analysis only if other factors known to influence PSA levels (antiandrogen withdrawal, radiation, a n d o r other concomitant anticancer therapies) were definitively excluded as potentially confounding variables. Results. The mean and median PSA decline after initiating prednisone was 33%(95% confidence interval [CI] 2 0 9 to 46’1;) and 24‘1; (range 0% to 99’1;), respectively. Ten patients (34%) had a PSA decline of more than 5 0 9 and 4 patients (14’1;) had PSA declines of more than 75%. The average and median time for progression-free survivals were 2.8 (95% CI 1.7 to 3.8) and 2.0 (range 0 to 111months. Four (14%) patients had PSA declines lasting 6 months or more. Median survival was 12.8 months. Additional analyses indicated that a PSA decline of more than 50’1;, compared with less than 50%, was associated with a longer survival. Toxicities included steroid myopathy ( n = 4), new-onset diabetes ( n = l ) , and dyspnea ( n = 1). Conclusions. Prednisone (10 mg orally two times a day) can decrease PSA by more than 5 0 8 in approximately one third of patients with hormone-refractory progressive prostate cancer. On the basis of comparisons with other data sets, we hypothesize a dose-response relationship between glucocorticoid dose and PSA decline. Editorial Comment: Many patients in whom hormonal therapy fails are not candidates for aggressive attempts at chemotherapy. This study provides reasonable data on the expectation following treatment with prednisone. Patrick C. Walsh. M.D.
Long Term Use of Megestrol Acetate by Cancer Survivors for the Treatment of Hot Flashes
S. K. QUELLA, C. L. LOPRINZI, J. A. SLOAN, N. L. VAUGHT, W. L. DEKREY, T. FISCHER, G. FINCK,N. PIERSON AND T. PISANSKY,Mayo Clinic and Mayo Foundation, Rochester, Minnesota, Siouxland Hematology-Oncology Associates, Sioux City and Iowa Oncology Research Association CCOP, Des Moines, Iowa, Grand Forks Clinic, Ltd., Grand Forks, and Quain and Ramstad Clinic, Bismarck, North Dakota, and Sioux Community Cancer Consortium, Sioux Falls, South Dakota Cancer, 82: 1784-1788,1998 BACKGROUND. Hot flashes are often a troublesome symptom in breast carcinoma survivors and men with prostate carcinoma who have undergone androgen deprivation therapy. A previous clinical study demonstrated that, on a short term basis, low dose megestrol acetate markedly reduced hot flashes and was well tolerated. Little information has been available regarding the long term use of low dose megestrol acetate for hot flashes. METHODS. Patients previously enrolled on a randomized placebo-controlled trial that evaluated the short term use of megestrol acetate for hot flashes were contacted and interviewed by telephone. RESULTS. A total of 132 persons were contacted. Nine percent of the patients discontinued megestrol acetate after resolution of their hot flashes. Forty-five percent of the patients contacted were continuing to utilize megestrol acetate approximately 3 years beyond the conclusion of the 1992 study. Three-quarters of these patients were utilizing 5 2 0 mg of megestrol acetate per day. Potential toxicities attributed to megestrol acetate included episodes of chills, appetite stimulatiodweight gain, vaginal bleeding, and carpal tunnel syndrome symptoms. CONCLUSIONS. A substantial proportion of patients continue to use megestrol acetate for periods of up to 3 years or longer with continued control of hot flashes. This treatment appears to be relatively well tolerated. Editorial Comment: Many patients on hormone therapy have hot flashes. I have not routinely used megestrol but this study indicates that maybe I should. The authors evaluated patients who were in a clinical trial for 8 weeks. Surprisingly, at least to me, 45%of patients continued to use megestrol for approximately 3 years, which suggests that it must be working. Patrick C. Walsh, M.D.