Estramustine (chemotherapy agent)

estramustine
Estramustine chemical structure

A derivative of the hormone estrogen, estramustine is a chemotherapy drug that has been in use for three decades against certain cases of prostate cancer.

Drug profile

  • Class: Alkylating agent
  • Mechanism of action: Estramustine adds an alkyl group to DNA, which causes damage to the cell and leads to cell death.
  • Treatment type: Chemotherapy
  • US approval: 1981
  • Synonyms: Emcyt
  • FDA Use-in-Pregnancy Rating: Not rated, although men receiving estramustine are at risk of fathering children with birth defects and should speak with their doctor about birth control efforts during this time, and how long they must use birth control after ceasing this drug before it is once again safe to father a child.

What estramustine is effective for and why

Estramustine has a single primary indication—for the treatment of prostate cancer, specifically as an agent of palliative care for patients with metastatic or progressive prostate cancer. The National Comprehensive Cancer Network considers estramustine, used in conjunction with docetaxel, as a possible first-line alternative chemotherapy treatment for prostate cancer, although docetaxel and prednisone is preferred since at least one study has shown that adding estramustine to docetaxel increased negative side effects without improving overall survival.

Estramustine side effects

While each patient will have his or her own experiences with the side effects of estramustine, many patients will likely experience chest and upper body pains, sudden cough, shortness of breath, rapid weight gain, pain/swelling in the lower extremities, sudden headache, nausea, diarrhea, loss of appetite, fatigue, impotence, or breast tenderness. Most if not all of these side effects should subside when one is finished with receiving estramustine. Patients are encouraged to report all side effects to their oncologist or oncology team.

Furthermore, patients with a history of blood clots, diabetes, hypertension, heart disease, migraines, liver disease, metabolic bone disorders, and epilepsy need to discuss these issues with their medical team prior to receiving estramustine.

Sources

  • Boyiadzis, Michael M. et al. Hematology-Oncology Therapy. 2007. New York: McGraw Hill, Medical Publishing Division.
  • National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology: Prostate Cancer, V.3.2010
  • Perry, Michael C, Editor. Companion Handbook to the Chemotherapy Sourcebook. 1999. Baltimore; Williams & Wilkins.
  • Drugs.com: Estramustine

Significant studies relating to estramustine


 

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