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Prospective Trial of the Herbal Supplement PC-SPES in Patients With Progressive Prostate Cancer

From the University of California at San Francisco, San Francisco, CA; and Memorial Sloan-Kettering Cancer Center, New York, NY.

Address reprint requests to Eric J. Small, MD, University of California at San Francisco, UCSF Comprehensive Cancer Center, 1600 Divisadero, 3rd Floor, San Francisco, CA 94115; email smalle{at}medicine.ucsf.edu

ABSTRACT

PURPOSE: PC-SPES is an herbal supplement for which there are anecdotal reports of anti–prostate cancer activity. This phase II study was undertaken to assess the efficacy and toxicity of PC-SPES in prostate cancer patients.

PATIENTS AND METHODS: Thirty-three patients with androgen-dependent prostate cancer (ADPCa) and 37 patients with androgen-independent prostate cancer (AIPCa) were treated with PC-SPES at a dose of nine capsules daily. Clinical outcome was assessed with serial serum prostate-specific androgen (PSA) level measurement and imaging studies.

RESULTS: One hundred percent of ADPCa patients experienced a PSA decline of 80%, with a median duration of 57+ weeks. No patient has developed PSA progression. Thirty-one patients (97%) had declines of testosterone to the anorchid range. Two ADPCa patients had positive bone scans; both improved. One patient with a bladder mass measurable on computed tomography scan experienced disappearance of this mass. Nineteen (54%) of 35 AIPCa patients had a PSA decline of 50%, including eight (50%) of 16 patients who had received prior ketoconazole therapy. Median time to PSA progression was 16 weeks (range, 2 to 69+ weeks). Of 25 patients with positive bone scans, two had improvement, seven had stable disease, 11 had progressive disease, and five did not have a repeat bone scan because of PSA progression. Severe toxicities included thromboembolic events (n = 3) and allergic reactions (n = 3). Other frequent toxicities included gynecomastia/gynecodynia, leg cramps, and grade 1 or 2 diarrhea.

CONCLUSION: PC-SPES seems to have activity in the treatment of both ADPCa and AIPCa and has acceptable toxicity. Further study is required to determine whether its effects exceed those expected with estrogen therapy.

NOTES

Presented in part at the Thirty-Fifth Annual Meeting of the American Society for Clinical Oncology, Atlanta, GA, May 15-18, 1999.

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