Department of Internal Medicine, Baylor College of Medicine, Houston, TX.
Castrate-resistant prostate cancer (CRPC) is the main cause of prostate cancer (PC) morbidity and mortality. Newer therapies have only modestly improved survival. CRPC patients' various comorbidities mean one must treat them cautiously. Cyclophosphamide, vincristine, and dexamethasone (CVD) therapy has a favorable risk-benefit profile, and diethylstilbestrol (DES) was used widely in PC. The patient we describe responded remarkably well to combination treatment with CVD plus DES. The 77-year-old man had fulminant CRPC with multiple comorbidities and bony metastases in March 2008. In May 2008 his prognosis was dismal: performance status score, 4; pancytopenia; platelet count, 51 × 10(9)/L; abnormal coagulation profile consistent with disseminated intravascular coagulopathy (DIC); and cranial images consistent with dural metastases. We administered 1 dose of CVD (cyclophosphamide 300 mg/m(2) intravenously [I.V.], vincristine 1 mg I.V., and dexamethasone 0.75 mg orally [p.o.] twice per day [b.i.d.]) plus DES (1 mg p.o. b.i.d.). He responded quickly with no clinically significant toxicity. His performance status improved and the platelet count increased to 89,000 × 10(9)/L. We administered maintenance CVD (cyclophosphamide 150 mg/day p.o. for 21 days every 28 days; vincristine 1 mg I.V. weekly; dexamethasone 0.5 mg p.o. b.i.d.) plus DES (1 mg p.o. b.i.d.) for 5 months. In January 2011, nearly 3 years after his initial treatment, he remained alive and well. CVD plus DES may help selected patients with advanced CRPC who are too ill to tolerate or benefit from other therapies.
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Reference: Clin Genitourin Cancer. 2011 May 14. Epub ahead of print.