前立腺癌に対する酢酸クロルマジノンの効果について

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1)未治療前立腺癌45例にCMA 100 mg/日を投与し(平均12.6ヵ月),そのうち42例について臨床効果の検討を行った.2)総合効果判定では著効19例(45.2%),有効14例(33.3%),やや有効4例(9.5%),無効5例(11.9%)であり著効,有効を合わせた33例(78.6%)を有用と判定した.3) Stage別有効率はA 100.0%,B 88.9%,C 77.8%,D 57.1%であり,stage Dにおける有効率が高かったのは,効果判定時期が投与開始6ヵ月後と比較的早かったためと思われた.4)副作用としてトリグリセライドの上昇,肝機能障害,インポテンツが各1例ずつに認められたがいずれも軽微なものであった.5)除睾術および非除睾術群の間で,テストステロン値は女性値レベルもしくはそれ以下に低下し,臨床的に有意差は認めなかったが,除睾術の臨床的意義は,なお否定されるものではない.6) CMAは前立腺癌の内分泌療法剤として十分有用であると考えられるがstage Dに対する効果は必ずしも満足すべきものではなかったForty five patients with previously untreated prostatic cancer were given chlormadinone acetate (CMA) at a dose of 100 mg/day (mean 12.6 months), and 42 of them were evaluated for effectiveness. Overall response evaluation revealed 19 complete responses (45.2%), 14 partial responses (33.3%), 4 minor responses (9.5%), and 5 were unresponsive (11.9%). Consequently CMA was judged to be effective in 33 patients (78.6%, complete and partial responses). Response rate was 100.0% for stage A, 88.9% for stage B, 77.8% for stage C, and 57.1% for stage D. The response rate for stage D was relatively high, possibly because the time of judgement of effectiveness was a little too early. As side effects, elevated triglyceride level, impaired liver function and impotence were noted in one patient each. All of them were slight. The testosterone level in both castrated and non-castrated patients were not higher than that in women, and no significant difference in the level was noted between the groups. Nevertheless, the clinical usefulness of castration is not denied. CMA is considered useful as an endocrine therapeutic drug, though its effect on the disease at stage D was insufficient. The administration method, such as sequential treatment and combination treatment of CMA and estrogen preparations, is a future subject.

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五島明彦
横浜市立大学医学部泌尿器科学教室

前立腺癌に対する酢酸クロルマジノンの効果について

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