Relief of symptoms in disease not responsive to hormones -
Prostate cancer does not kill most of the men who develop it, but
progressive disease that is not responsive to hormone-based
treatments is both lethal, and with its propensity to invade
bone, particularly painful. There is no chemotherapy that
provides significant palliation. That is why a Canadian report
in the June, 1996 issue of the Journal of Clinical Oncology is of
interest. The researchers randomly assigned 161 patients whose
disease was not responsive to hormone therapy to treatment with
either prednisone or prednisone plus mitoxantrone. Patient-
reported decrease in pain (2 points on a 6-point scale) was the
palliative response; other criteria end points were a 50% or more
decrease in needed analgesic medication, duration of response,
and survival. Palliative response occurred in 29% of those on
combination versus 12% of those on prednisone alone, while the
duration of this effect was 43 and 18 weeks in the two groups,
respectively. Reduced need for analgesic medication was noted in
about 9% of those in both groups. Reduction in serum PSA levels
was greater in the mitoxantrone group but the difference was not
statistically significant. Eleven of the 81 patients on
prednisone responded to mitoxantrone subsequently. Treatment was
well tolerated, although there were five possible cardiac events
in the 130 treated with mitoxantrone. (Tannock, J Clin Oncol
14:1756, 1996; see also the editorial on page 1753 of the same
issue)
Editor's Comment: - The data provides some hope for palliation in
this grim disease.
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