Docetaxel, Estramustine, and Exisulind in Treating Patients With Metastatic Prostate Cancer That Has Not Responded to Hormone Therapy

A Phase II Study Of Estramustine, Docetaxel, And Exisulind (IND #64733) In Men With Hormone Refractory Prostate Cancer

RATIONALE: Androgens can stimulate the growth of prostate cancer cells. Estramustine may fight prostate cancer by reducing the production of androgens. Exisulind may stop the growth of prostate cancer by stopping blood flow to the tumor. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining these therapies may kill more tumor cells.

PURPOSE: Phase II trial to study the effectiveness of combining estramustine with exisulind and docetaxel in treating patients who have metastatic prostate cancer that has not responded to hormone therapy.

OBJECTIVES:

• Determine the time to objective and biochemical progression and response proportion (objective and post-therapy changes in PSA) in patients with hormone refractory metastatic prostate cancer treated with docetaxel, estramustine, and exisulind.
• Determine the toxic effects of this regimen in these patients.
• Determine the overall survival of patients treated with this regimen.

OUTLINE: Patients receive oral estramustine 3 times daily on days 1-5, docetaxel IV over 1 hour on day 2, and oral exisulind twice daily on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Patients are followed every 3 months for 2 years.

DISEASE CHARACTERISTICS:

• Histologically confirmed adenocarcinoma of the prostate

  • Progressive systemic (metastatic) disease despite castrate levels of testosterone secondary to orchiectomy or luteinizing hormone-releasing hormone (LHRH) agonist therapy

    • Castrate levels of testosterone must be maintained
    • LHRH analog therapy should be continued

  • Failed prior standard androgen-deprivation therapy

  • Serum testosterone no greater than 50 ng/mL for patients who have not had bilateral orchiectomy

• Evidence of metastatic disease on CT scan, MRI, or bone scan (no positron-emission tomography or prostascint)

• Evidence of progressive disease after most recent prior therapy (including hormonal therapy) as defined by 1 of the following:

  • Measurable disease progression

    • More than 20% increase in the sum of the longest diameters of target lesions from the time of maximal regression or the appearance of 1 or more new lesions

  • Bone scan progression

    • Appearance of 1 or more new lesions on bone scan attributable to prostate cancer AND
    • PSA at least 5 ng/mL

  • PSA progression

    • PSA at least 5 ng/mL which has increased serially from baseline on 2 occasions (at least 1 week apart) NOTE: If the confirmatory PSA is less than screening PSA, an additional test for rising PSA is required

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• ECOG 0-2

Life expectancy

• Not specified

Hematopoietic

• Granulocyte count at least 1,500/mm^3
• Platelet count at least 100,000/mm^3

Hepatic

• AST and ALT no greater than 1.5 times upper limit of normal (ULN)
• Bilirubin no greater than ULN

Renal

• Creatinine no greater than 1.5 times ULN

Cardiovascular

• No myocardial infarction within the past year
• No significant change in anginal pattern within the past year
• No congestive heart failure
• No New York Heart Association class II-IV heart disease
• No deep vein thrombosis within the past year

Pulmonary

• No pulmonary embolus within the past year

Other

• No clinically significant peripheral neuropathy
• No known hypersensitivity to sulindac
• Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy

• Not specified

Chemotherapy

• No prior cytotoxic chemotherapy (including estramustine or suramin)
• No other concurrent chemotherapy

Endocrine therapy

• See Disease Characteristics

• At least 4 weeks since prior flutamide and megestrol

• At least 6 weeks since prior bicalutamide and nilutamide

• At least 4 weeks since prior hormonal therapy known to decrease PSA levels (including ketoconazole, aminoglutethimide, finasteride, or any systemic corticosteroid)

• Concurrent primary testicular androgen suppression therapy (e.g., with a LHRH analog) allowed

• No other concurrent hormonal therapy except:

  • Steroids for adrenal insufficiency
  • Hormones for non-disease-related conditions (e.g., insulin for diabetes)
  • Intermittent dexamethasone as an antiemetic

Radiotherapy

• At least 4 weeks since prior radiotherapy and recovered
• At least 8 weeks since prior strontium chloride Sr 89 or samarium Sm 153 lexidronam pentasodium
• No concurrent palliative radiotherapy

Surgery

• See Disease Characteristics
• At least 4 weeks since prior major surgery and recovered

Other

• At least 4 weeks since prior herbal product known to decrease PSA levels (including saw palmetto, PC-SPES)

• More than 1 week since prior sulindac

• No concurrent sulindac

• No concurrent chronic nonsteroidal anti-inflammatory drugs (including COX-2 inhibitors and salicylates such as aspirin, mesalamine, salsalate, and sulfasalazine)

  • Concurrent ibuprofen and naproxen allowed
  • Low-dose aspirin (e.g., 81 mg/day) for cardiovascular prevention allowed

• No concurrent full-dose oral or parenteral anticoagulation therapy

• Concurrent bisphosphonate therapy allowed provided therapy was initiated at least 4 weeks before study and disease has progressed despite therapy