Weekly paclitaxel, estramustine phosphate, and oral etoposide in the treatment of hormone‐refractory prostate carcinoma

BACKGROUND The objective of the current study was to evaluate the efficacy and toxicity of weekly paclitaxel, oral etoposide, and estramustine phosphate in the treatment of patients with advanced, hormone‐refractory prostate carcinoma. METHODS Patients with hormone‐refractory prostate carcinoma who had received no more than one previous chemotherapy regimen were eligible for this trial. Forty‐two patients were treated between February 1998 and March 2000. Toxicity was excessive in the first 3 patients treated (Grade 3–4 leukopenia, 3 patients; death due to sepsis, 1 patient); the remaining 39 patients received lower doses of etoposide and estramustine phosphate (paclitaxel 50 mg/m2 as a 1‐hour, intravenous infusion on Days 1, 8, 15; etoposide 50 mg orally twice daily on Days 1–10; and estramustine phosphate 280 mg orally 3 times daily on Days 1–10). Courses were repeated every 28 days. Patients were evaluated for objective and/or serologic response after two courses of treatment; responding patients continued treatment for six courses. RESULTS Fourteen of 40 evaluable patients (35%) had either an objective response or a serologic response to treatment. The median survival for the entire group was 9.5 months, with 1‐year, 2‐year, and 3‐year survival rates of 38%, 12%, and 10%, respectively. Neutropenia was the most common Grade 3–4 toxicity and occurred in 38% of patients (11% of courses). Thirteen patients (33%) had severe fatigue, and 2 patients had treatment‐related deaths due to sepsis. CONCLUSIONS Although the three‐drug combination had activity in patients with hormone‐refractory prostate carcinoma, the results did not appear any better than the results achieved with less toxic taxane/estramustine phosphate combinations. Further development of this three‐drug regimen is not recommended. Cancer 2003. © 2003 American Cancer Society. The authors evaluated the efficacy and toxicity of weekly paclitaxel, oral etoposide, and estramustine phosphate in the treatment of patients with hormone‐refractory prostate carcinoma. The results did not appear to be better than the results achieved with less toxic taxane/estramustine phosphate combinations. Further development of this three‐drug regimen is not recommended. See also pages 2088–90.