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Suramin Therapy for Patients With Symptomatic Hormone-Refractory Prostate Cancer: Results of a Randomized Phase III Trial Comparing Suramin Plus Hydrocortisone to Placebo Plus Hydrocortisone

From the University of California at San Francisco Comprehensive Cancer Center, San Francisco; University of California at Davis Cancer Center, Sacramento; and Cedars-Sinai Cancer Center, Los Angeles, CA; Parke-Davis Pharmaceutical Research, Division of Warner-Lambert Co, Ann Arbor, MI; Southeastern Medical Oncology Center, Goldsboro, NC; Hamilton Regional Cancer Center, Hamilton, Ontario, Canada; and Johns Hopkins University, Baltimore, MD.

Address reprint requests to Eric J. Small, MD, University of California at San Francisco, UCSF-Mount Zion Cancer Center, 2356 Sutter St, 5th Floor, San Francisco, CA 94115; email smalle{at}medicine ucsf.edu.

PURPOSE: Suramin is a novel agent that has demonstrated preliminary evidence of antitumor activity in hormone-refractory prostate cancer (HRPC). A prospective randomized clinical trial was designed to evaluate pain and opioid analgesic intake as surrogates for antitumor response in HRPC patients with significant, opioid analgesic–dependent pain.

PATIENTS AND METHODS: A double-blind, placebo-controlled trial randomized patients to receive a 78-day, outpatient regimen of either suramin plus hydrocortisone (HC, 40 mg/d) or placebo plus HC. Treatment assignment was unblinded when either disease progression or dose-limiting toxicity occurred; placebo patients were allowed to cross-over to open-label suramin plus HC. In addition to pain and opioid analgesic intake, prostate-specific antigen (PSA) response, time to disease progression, quality of life, performance status, and survival were compared.

RESULTS: Overall mean reductions in combined pain and opioid analgesic intake were greater for suramin plus HC (rank sum P = .0001). Pain response was achieved in a higher proportion of patients receiving suramin than placebo (43% v 28%; P = .001), and duration of response was longer for suramin responders (median, 240 v 69 days; P = .0027). Time to disease progression was longer (relative risk = 1.5; 95% confidence interval, 1.2 to 1.9) and the proportion of patients with a greater than 50% decline in PSA was higher (33% v 16%; P = .01) in patients who received suramin. Neither quality of life nor performance status was decreased by suramin treatment, and overall survival was similar. Most adverse events were of mild or moderate intensity and were easily managed medically.

CONCLUSION: Outpatient treatment with suramin plus HC is well tolerated and provides moderate palliative benefit and delay in disease progression for patients with symptomatic HRPC.

Sponsored by Parke-Davis Pharmaceutical Research.

E.J.S., L.M.R., R.B.N., and M.E. have served on a suramin advisory board for Parke-Davis Pharmaceutical Research, the manufacturer of suramin and sponsor of this trial. F.J.M., P.F.L., and L.C. are employees of Parke-Davis Pharmaceutical Research.

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