Treatment of advanced prostate cancer with cyclophosphamide, doxorubicin, and methotrexate

Twenty-three patients with advanced prostate cancer who had failed previous hormone therapy were treated with cyclophosphamide, doxorubicin, and methotrexate on a 3-week course. Of the 22 evaluable patients, over one-half had poor performance status, increased acid and alkaline phosphatase levels, and pain. Parameters which improved in greater than 50% of cases included acid and alkaline phosphatase levels, pain, performance status, and measurable lesions (lung and soft tissue). Initial parameters associated with a significantly decreased survival were age greater than 66 years, increased pain, poor performance status, and increasing alkaline phosphatase. Prior radiation therapy was associated with increased drug toxicity, lower doses of chemotherapy, and decreased survival (not significant). There was a significant relationship between the degree of improvement of acid phosphatase, alkaline phosphatase, pain, and performance status to increased survival. Three categories of response were defined based on these parameters. The mean survival of seven patients with partial response (106 weeks) is significantly longer than that of seven with measurable response (57 weeks) and eight with no response (26 weeks). Four patients had severe leukopenia and one died of sepsis. These results compare favorably with previous reports of chemotherapy treatment of advanced prostate cancer.