Experience with using fosfestrol for treating metastatic castrate-resistant prostate cancer in resource-limited setting
Background: Fosfestrol is a low-cost estrogen analog that is useful in the management of metastatic prostate cancer in resource-challenged settings. It acts by altering the pituitary axis, adrenal secretion, and 5-alpha reductase activity. Patients and Methods: The outcomes of metastatic castration-...
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2019-01-01
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| Series: | Indian Journal of Medical and Paediatric Oncology |
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| Online Access: | http://www.ijmpo.org/article.asp?issn=0971-5851;year=2019;volume=40;issue=1;spage=79;epage=84;aulast= |
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| author | Jayachandran Perumal Kalaiyarasi Venkatraman Radhakrishnan Trivadi S Ganesan Anand Raja Prasanth Ganesan Manikandan Dhanushkodi Tenali Gnana Sagar |
| author_facet | Jayachandran Perumal Kalaiyarasi Venkatraman Radhakrishnan Trivadi S Ganesan Anand Raja Prasanth Ganesan Manikandan Dhanushkodi Tenali Gnana Sagar |
| author_sort | Jayachandran Perumal Kalaiyarasi |
| collection | DOAJ |
| description | Background: Fosfestrol is a low-cost estrogen analog that is useful in the management of metastatic prostate cancer in resource-challenged settings. It acts by altering the pituitary axis, adrenal secretion, and 5-alpha reductase activity. Patients and Methods: The outcomes of metastatic castration-resistant prostate cancer patients treated with fosfestrol in our center between June 2012 and December 2015 were analyzed retrospectively. Fosfestrol was given orally at a dose of 120 mg thrice daily. Event was defined as the discontinuation of fosfestrol due to tumor progression or drug toxicity or death due to any cause. The event-free survival (EFS) and overall survival (OS) were calculated by the Kaplan–Meier method. Results: The analysis included 47 patients with a median age of 65 years. Initial Gleason score was available for 41 of 47 patients, of which 17% (7), 39% (16), and 44% (18) were low risk, intermediate risk, and high risk, respectively. The most common site of metastasis was bone (98%). Of 47 patients, 32 (68%) received fosfestrol as the second line of treatment after progression on complete androgen blockade, 14/47 (30%) received it as the third line, and 1/47 received it as the fourth line of treatment. The median prostate-specific antigen (PSA) value at the start of fosfestrol and the nadir PSA value were 43.7 ng/ml and 13.1 ng/ml, respectively. Ninety-one percent (n = 43) of patients had not been previously treated with chemotherapy (docetaxel). Response of PSA of >50% was observed in 55% (n = 26) of patients. The median EFS and median OS after the start of fosfestrol were 6.8 and 14.7 months, respectively, with a median follow-up of 10.9 months. Only two patients developed Grade 3 toxicity, both of whom had diarrhea. Conclusions: In resource-challenged settings, oral fosfestrol is an effective, cheap, and safe option for the management of metastatic prostate cancer progressing after first-line complete androgen blockade. |
| format | Article |
| id | doaj-art-21c48cbebcfb4dadb9393ff5d7f038ec |
| institution | DOAJ |
| issn | 0971-5851 0975-2129 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
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| series | Indian Journal of Medical and Paediatric Oncology |
| spelling | doaj-art-21c48cbebcfb4dadb9393ff5d7f038ec2025-08-20T03:03:51ZengThieme Medical and Scientific Publishers Pvt. Ltd.Indian Journal of Medical and Paediatric Oncology0971-58510975-21292019-01-01401798410.4103/ijmpo.ijmpo_259_17Experience with using fosfestrol for treating metastatic castrate-resistant prostate cancer in resource-limited settingJayachandran Perumal KalaiyarasiVenkatraman RadhakrishnanTrivadi S GanesanAnand RajaPrasanth GanesanManikandan DhanushkodiTenali Gnana SagarBackground: Fosfestrol is a low-cost estrogen analog that is useful in the management of metastatic prostate cancer in resource-challenged settings. It acts by altering the pituitary axis, adrenal secretion, and 5-alpha reductase activity. Patients and Methods: The outcomes of metastatic castration-resistant prostate cancer patients treated with fosfestrol in our center between June 2012 and December 2015 were analyzed retrospectively. Fosfestrol was given orally at a dose of 120 mg thrice daily. Event was defined as the discontinuation of fosfestrol due to tumor progression or drug toxicity or death due to any cause. The event-free survival (EFS) and overall survival (OS) were calculated by the Kaplan–Meier method. Results: The analysis included 47 patients with a median age of 65 years. Initial Gleason score was available for 41 of 47 patients, of which 17% (7), 39% (16), and 44% (18) were low risk, intermediate risk, and high risk, respectively. The most common site of metastasis was bone (98%). Of 47 patients, 32 (68%) received fosfestrol as the second line of treatment after progression on complete androgen blockade, 14/47 (30%) received it as the third line, and 1/47 received it as the fourth line of treatment. The median prostate-specific antigen (PSA) value at the start of fosfestrol and the nadir PSA value were 43.7 ng/ml and 13.1 ng/ml, respectively. Ninety-one percent (n = 43) of patients had not been previously treated with chemotherapy (docetaxel). Response of PSA of >50% was observed in 55% (n = 26) of patients. The median EFS and median OS after the start of fosfestrol were 6.8 and 14.7 months, respectively, with a median follow-up of 10.9 months. Only two patients developed Grade 3 toxicity, both of whom had diarrhea. Conclusions: In resource-challenged settings, oral fosfestrol is an effective, cheap, and safe option for the management of metastatic prostate cancer progressing after first-line complete androgen blockade.http://www.ijmpo.org/article.asp?issn=0971-5851;year=2019;volume=40;issue=1;spage=79;epage=84;aulast=Castration-resistant prostate cancerdiethylstilbestrol diphosphatefosfestrolprostate-specific antigensurvival |
| spellingShingle | Jayachandran Perumal Kalaiyarasi Venkatraman Radhakrishnan Trivadi S Ganesan Anand Raja Prasanth Ganesan Manikandan Dhanushkodi Tenali Gnana Sagar Experience with using fosfestrol for treating metastatic castrate-resistant prostate cancer in resource-limited setting Indian Journal of Medical and Paediatric Oncology Castration-resistant prostate cancer diethylstilbestrol diphosphate fosfestrol prostate-specific antigen survival |
| title | Experience with using fosfestrol for treating metastatic castrate-resistant prostate cancer in resource-limited setting |
| title_full | Experience with using fosfestrol for treating metastatic castrate-resistant prostate cancer in resource-limited setting |
| title_fullStr | Experience with using fosfestrol for treating metastatic castrate-resistant prostate cancer in resource-limited setting |
| title_full_unstemmed | Experience with using fosfestrol for treating metastatic castrate-resistant prostate cancer in resource-limited setting |
| title_short | Experience with using fosfestrol for treating metastatic castrate-resistant prostate cancer in resource-limited setting |
| title_sort | experience with using fosfestrol for treating metastatic castrate resistant prostate cancer in resource limited setting |
| topic | Castration-resistant prostate cancer diethylstilbestrol diphosphate fosfestrol prostate-specific antigen survival |
| url | http://www.ijmpo.org/article.asp?issn=0971-5851;year=2019;volume=40;issue=1;spage=79;epage=84;aulast= |
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