Paclitaxel, Topotecan, and Estramustine in Treating Patients With Metastatic Hormone-Refractory Prostate Cancer

DISEASE CHARACTERISTICS:

• Histologically confirmed adenocarcinoma of the prostate gland

  • Progressive metastatic disease (e.g., bone, pelvic mass, lymph node, liver or lung metastases)
  • Radiologic evidence of hydronephrosis alone dose not constitute metastatic disease

• Failed prior primary hormonal therapy (e.g., estrogen therapy, luteinizing hormone-releasing hormone blocker and flutamide) or bilateral orchiectomy

  • Patients previously treated with flutamide or bicalutamide must have evidence of disease progression i.e., increasing Prostate-Specific Antigen (PSA)
• PSA level ≥ 10 ng/mL if bone metastases only are present (i.e., lacking measurable soft tissue disease)
• No elevated serum acid phosphatase or PSA level as the only evidence of disease
• No carcinomatous meningitis or brain metastases

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• Eastern Cooperative Oncology Group (ECOG) 0-2

Life expectancy

• At least 12 weeks

Hematopoietic

• White Blood Cell (WBC) ≥ 4,000/mm^3 OR
• Granulocyte count ≥ 2,000/mm^3
• Platelet count ≥ 100,000/mm^3

Hepatic

• Serum Glutamic-Oxaloacetic Transaminase(SGOT) and Serum Glutamic-Pyruvic Transaminase (SGPT) ≤ 2 times normal
• Bilirubin ≤ 1.5 mg/dL

Renal

• Creatinine ≤ 2.0 mg/dL OR
• Creatinine clearance ≥ 50 mL/min

Cardiovascular

• History of deep venous thrombosis allowed provided patients are maintained on therapeutic anticoagulation therapy
• No active angina pectoris
• No New York Heart Association class II-IV heart disease
• No myocardial infarction within the past 6 months
• No thrombosis within the past 3 months

Other

• Fertile patients must use effective contraception during and for 3 months after study participation
• No active infection
• No other concurrent serious medical illness that would preclude study participation
• No other malignancy within the past 3 years except curatively treated basal cell or squamous cell skin cancer

PRIOR CONCURRENT THERAPY:

Biologic therapy

• Not specified

Chemotherapy

• No prior chemotherapy

Endocrine therapy

• See Disease Characteristics
• At least 4 weeks since prior flutamide
• At least 8 weeks since prior bicalutamide

Radiotherapy

• More than 4 weeks since prior radiotherapy
• No prior strontium chloride Sr 89 or samarium Sm 153 lexidronam pentasodium

Surgery

• See Disease Characteristics

Other

• Recovered from all prior therapy
• No prior cytotoxic therapy for prostate cancer
• No concurrent milk, milk products, antacids, calcium-containing drugs, or food during estramustine administration