Skip to main content

Part of the book series: Cancer Treatment and Research ((CTAR,volume 78))

Abstract

Estramustine phosphate (Emcyt, Estracyt, estradiol-3-bis (2 chloroethyl) carbamate-17-dihydrogen monophosphate), synthesized in the 1960s [1], was designed and developed for the treatment of breast cancer following the observation of the presence of estrogen receptors in normal breast tissue and tumors [2]. The design of the drug was based on the hypothesis that conjugation of 17-B estradiol with the alkylating agent nor-nitrogen mustard would allow the transport of the cytotoxic agent directly to the steroiddependent tumor cells by virtue of binding to estrogen receptors. This mechanism would then result in improved specificity for the target cells, and at the same time, reduce bone marrow and liver toxicity [3]. The concept leading to synthesis of estramustine phosphate was also based on the beneficial effect observed in prostate cancer of a polyestrodiol phosphate (Estradurin) [4].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Fex HJ, Hogberg KB, Könyves I, Kneip P. Certain steroid N-bis-(haloethyl) carbamates. USA Patent #3, 299 104, 17.1, 1967.

    Google Scholar 

  2. Schein PS. Estramustine: Historical background and preclinical trials. Semin Oncol 10(Suppl 3):l–2, 1983.

    Google Scholar 

  3. Könyves I, Liliekvist J. The steroid molecule as a carrier of cytotoxic groups. In Biological characterization of human tumors, Excerpta Med Internat Congress Series 375:98–105, 1976.

    Google Scholar 

  4. Jönsson G, Röhl L, Wiegner K. Treatment of prostatic carcinoma with a new, water soluble estrogen preparation, estradurin. Acta Chir Scand 113:68–71, 1957.

    PubMed  Google Scholar 

  5. Jönsson G, Högberg B. Treatment of advanced prostatic carcinoma with Estracyt®. Scand J Urol Nephrol 5:103–107, 1971.

    Article  PubMed  Google Scholar 

  6. Mittelman A, Shukla SK, Murphy GP. Extended therapy of stage D carcinoma of the prostate with oral estramustine phosphate. J Urol 115:409–412, 1976.

    PubMed  CAS  Google Scholar 

  7. Hartley-Asp B. Estramustine induced mitotic arrest in two human prostatic carcinoma cell lines DU 145 and PC-3. Prostate 5:93–100, 1984.

    Article  PubMed  CAS  Google Scholar 

  8. Hartley-Asp B, Gunnarsson PO. Growth and cell survival following treatment with estramustine, nor-nitrogen mustard, estradiol and testosterone of a human prostatic cancer cell line (DU 145). J Urol 127:818–822, 1982.

    PubMed  CAS  Google Scholar 

  9. Hartley-Asp B. Cytotoxic and antimitotic effects of estramustine in vivo. Cell Pharmacol l(Suppl 1):S59–S62, 1993.

    Google Scholar 

  10. Tew KD, Sterns ME. Hormone independent, non-alkylating mechanism of cytotoxicity for estramustine. Urol Res 15:155–160, 1987.

    Article  PubMed  CAS  Google Scholar 

  11. Tritsch GL, Shukla SK, Mittelman A, Murphy GP. Estracyt as a substrate for phosphatase in human serum. Invest Urol 12:38–39, 1974.

    PubMed  CAS  Google Scholar 

  12. Pousette A, Björk P, Carlstrom K, et al. Prostatic secretion protein, an androgen-sensitive protein in rat and human prostate. Int Congr Ser 515:153–155, 1981.

    Google Scholar 

  13. Björk PA, Fluchter SH, Neide HJ. Estramustine binding protein — a marker for effect of therapy in prostatic carcinoma? Scand J Urol Nephrol (Suppl 107):59–64, 1988.

    Google Scholar 

  14. Kirdani RY, Corrales JJ, Hoisaeter PA, et al. Estramustine binding in rat, baboon and human prostate measured by high pressure liquid chromatography. Steroids 37:471–484, 1981.

    Article  PubMed  CAS  Google Scholar 

  15. Heyns W, Bossyns D. A comparative study of estramustine and pregnenolone binding to prostatic binding protein: evidence for subunit cooperativity. J steroid Biochem 19: 1689–1694, 1983.

    Article  PubMed  CAS  Google Scholar 

  16. Björk P, Isaacs JT, Hartley-Asp B. Estramustine binding protein (EMBP) in rat R3327 Dunning tumors: partial characterization and effect of hormonal withdrawal, hormone replacement, and cytotoxic treatment on its expression. Prostate 18:181–200, 1991.

    Article  PubMed  Google Scholar 

  17. Bergh J, Björk P, Westlin JE, Nelsson S. Expression of an estramusting-binding protein in human lung cancer cell lines. Cancer Res 48:4615–4619, 1988.

    PubMed  CAS  Google Scholar 

  18. Forsgren B, Björk P, Carlstrom K, et al. Purification and distribution of a major protein in rat prostate that binds estramustine, a nitrogen mustard derivative of estradiol-17-beta. Proc Natl Acad Sci USA 76:3149–3153, 1979.

    Article  PubMed  CAS  Google Scholar 

  19. Petrow V, Padilla GM. Design of cytotoxic steroids for prostate cancer. Prostate 9: 169–182, 1986.

    Article  PubMed  CAS  Google Scholar 

  20. Wang M, Tew KD, Stearns ME. Immunofluorescent studies of the anti-microtubule effects of the anti-cancer drug estramustine. Anticancer Res 7:1165–1171, 1987.

    PubMed  CAS  Google Scholar 

  21. Friden B, Wallin M, Deinum J, et al. Effect of estramustine phosphate on the assembly of trypsin-treated microtubules and microtubules reconstituted from purified tubulin with either Tau, MAP2, or the tubulin binding fragment of MAP2. Arch Biochem Biophys 257:123–130, 1987.

    Article  PubMed  CAS  Google Scholar 

  22. Stearns ME, Tew KD. Estramustine binds MAP-2 to inhibit microtubule assembly in vitro. Cell Science 89:331–342, 1988.

    CAS  Google Scholar 

  23. Dahllof B, Billstrom A, Cabrai F, Hartley-Asp B. Estramustine depolymerizes microtubules by binding to tubulin. Cancer Res 53:4573–4581, 1993.

    PubMed  CAS  Google Scholar 

  24. Sheridan VR, Speicher LA, Tew KD. The effects of estramustine on metaphase and anaphase in DU 145 prostatic carcinoma cells. Eur J Cell Biol 54:268–276, 1991.

    PubMed  CAS  Google Scholar 

  25. Tew DK, Erickson LC, White G, et al. Cytotoxicity of estramustine, a steroid-nitrogen mustand derivative through non DNA targets. Mol Pharmacol 24:327–328, 1983.

    Google Scholar 

  26. Tew KD. The mechanism of action of estramustine. Semin Oncol 10(Suppl 3):21–26,1983.

    PubMed  CAS  Google Scholar 

  27. Von Schoultz E, Grankvist K, Gustavsson H, Henriksson R. Effects of estramustine on DNA and cell membrane in malignant glioma cells. Acta Oncol 30:719–723, 1991.

    Google Scholar 

  28. Von Schoultz E, Lundgren E, Hendricksson R. Effects of estramustine and its constituents on human malignant glioma cells. Anticancer Res 10:693–696, 1990.

    Google Scholar 

  29. Speicher LA, Sheridan VR, Godwin AK, Tew KD. Resistance to the antimitotic drug estramustine is distinct from multidrug resistant phenotype. Br J Cancer 64:267–273,1991.

    Article  PubMed  CAS  Google Scholar 

  30. Pommerenke EW, Osswald H, Hahn EW, Volm M. Activity of various amphiphilic agents in reversing multidrug resistance of L1210 cells. Cancer Lett 55:17–23, 1990.

    Article  PubMed  CAS  Google Scholar 

  31. Speicher LA, Barone LR, Chapman AE, et al. P-glycoprotein binding and modulation of the multidrug resistant phenotype by estramustine. J Natl Cancer Inst 86:688–694, 1994.

    Article  PubMed  CAS  Google Scholar 

  32. Martinez J, Santibanez JF, Vial C, Maccioni RB. The antineoplastic agent estramustine and the derivative estramustine-phosphate inhibit secretion of interleukin-3 in leukemic cells. Possible roles of MAPs. Mol Cell Biochem (Netherlands) 117:165–173, 1992.

    CAS  Google Scholar 

  33. Hoisaeter PA. The effect of oestradiol-3N-bis-2-chloroethyl)-carbamate-17-beta-phosphate (Estracyt) on the 5-alpha-reductase in the rat ventral prostate. Acta Endocrin 80:188–198, 1975.

    CAS  Google Scholar 

  34. Sandberg AA, Muntzing J, Kadohama N, et al. Some new approaches to potential test systems for drugs against prostatic cancer. Cancer Treat Rep 61:289–295, 1977.

    PubMed  CAS  Google Scholar 

  35. Everitt E, Ekstrand H, Boberg B, Hartley-Asp B. Estramustine phosphate reversibly inhibits an early stage during adenovirus replication. Arch Virol 111:15–18, 1990.

    Article  PubMed  CAS  Google Scholar 

  36. Wang M, Stearns ME. Blocking of collaginase secretion by estramustine during in vitro tumor cell invasion. Cancer Res 48:6262–6271, 1988.

    PubMed  CAS  Google Scholar 

  37. Mareel MM, Storme GA, Dragonetti CH, et al. Antiinvasive activity of estramustine on malignant MO4 mouse cells and on DU-145 human prostate carcinoma cells in vitro. Cancer Res 48:1842–1849, 1988.

    PubMed  CAS  Google Scholar 

  38. Bjermer L, Von Schoultz E, Norberg B, Henriksson R. Estramustine inhibits monocyte phagocytosis. Prostate 13:49–55, 1988.

    Article  PubMed  CAS  Google Scholar 

  39. Hofman R, Lehmer A, Braun J, Bauer S. Activity of phagocytic granulocytes in patients with prostatic cancer. Urol Res 14:327–330, 1986.

    Google Scholar 

  40. Yamanaka H, Shida K. Pharmacology and metabolism of a new therapeutic drug for prostate cancer ‘Estracyt.’ Gan Tokagaku Mar 11:537–544, 1984.

    CAS  Google Scholar 

  41. Hoisaeter PA, Bakke A. Estramustine phosphate (Estracyt®): experimental and clinical studies in Europe. Semin Oncol 10(Suppl 3):27–33, 1983.

    PubMed  CAS  Google Scholar 

  42. Kadohama N, Kirdani RY, Madajewicz S, et al. Estramustine: metabolic pattern and possible mechanisms for its action in prostate cancer. NYS J Med 79:1005–1009, 1979.

    CAS  Google Scholar 

  43. Jönsson G, Olsson AM, Luttrop W, et al. Treatment of prostatic carcincoma with various types of estrogen derivatives. Vitam Horm 33:351–376, 1975.

    Article  PubMed  Google Scholar 

  44. Sandberg AA. Metabolic aspects and actions unique to Estracyt®. Semin Oncol 10(Suppl 3):3–14, 1983.

    PubMed  CAS  Google Scholar 

  45. Gunnarsson PO, Forshell GP. Clinical pharmacokinetics of estramustine phosphate. Urology 23 (Suppl 6):22–27, 1984.

    Article  PubMed  CAS  Google Scholar 

  46. Fritjofsson A, Björk P, Gunnarsson PO, Norlen BJ. Binding and accumulation of active metabolites in tumors from prostatic cancer patients treated with Estracyt. Preliminary report. Presented at 13th Int Cong Chemother, Vienna, 1983.

    Google Scholar 

  47. Gunnarsson O, Andersson SB, Johansson SA. The hydrolysis of estramustine phosphate; in vitro studies. Eur J Drug Metab Pharmacokinet 8:395–402, 1983.

    Article  PubMed  CAS  Google Scholar 

  48. Könyves I, Liljekvist J. The steroid molecule as a carrier of cytotoxic groups. Advances in Tumor Prevention, Detection and Characterization of Human Tumor: 6th International Symposium on the Biological Characterization of Human Tumors, Copenhagen, May 13-16, 1975. American Elsevier: New York, vol 3, 1976.

    Google Scholar 

  49. Müntzing J, Jensen G, Hogberg B. Pilot study on the growth inhibition by estramustine phosphate (Estracyt) of rat mammary tumors sensitive and insensitive to estrogens. Acta Pharmacol Toxicol 44:1–6, 1979.

    Article  Google Scholar 

  50. Hansenson M, Lundh B, Hartley-Asp B, Pousette A. Growth inhibiting effect of estramustine on two prostatic carcinoma cell lines, LNCaP and LNCaP-r. Urol Res 16:357–361, 1988.

    Article  PubMed  CAS  Google Scholar 

  51. Hansenson M. Difference in uptake of 3H-estramustine in two human prostatic carcinoma cell lines, LNCaP and LNCaP-r. Urol Res 17:103–106, 1989.

    Google Scholar 

  52. Gunnarsson PO, Andersson SB, Sandberg AA, Ellman M. Accumulation of estramustine and estromustine in adipose tissue of rats and humans. Cancer Chemother Pharmacol 28:361–364, 1991.

    Article  PubMed  CAS  Google Scholar 

  53. Shiina H, Sumi H, Ishibe T, Usui T. Relationship of thyroid to estramustine binding protein (EMBP) concentration in rat prostate. Andrologia 23:145–149, 1991.

    Article  PubMed  CAS  Google Scholar 

  54. Neubauer BL, Best KL, Goode RL, et al. Comparative antitumor effects of hormonal ablation estrogen agonist, estrogen cytotoxic derivatine, an antiestrogen in the PA III rat prostatic adenocarcinoma. Cancer Res 52:4663–4671, 1992.

    PubMed  CAS  Google Scholar 

  55. Jönsson G, Hogberg B, Nilsson T. Treatment of advanced prostatic carcinoma with estramustine phosphate (Estracyt). Scand J Urol Nephrol 11:231–238, 1977.

    Article  PubMed  Google Scholar 

  56. Takayasu H, Shida K, Marnose S, et al. A clinical study of the treatment of prostatic carcinoma with estramustine phosphate (Estracyt). Nishinihon J Urol 42:715–731, 1980.

    Google Scholar 

  57. Veronesi A, Zattoni F, Frustaci S, et al. Estramustine phosphate (Estracyt) treatment of T3-T4 prostatic carcinoma. Prostate 3:159–164, 1982.

    Article  PubMed  CAS  Google Scholar 

  58. Slack NH, Brady MF, Murphy GP. Observations of prolonged use of oral Emcyt in prostatic cancer patients. Urology 20:515–523, 1982.

    Article  PubMed  CAS  Google Scholar 

  59. Benson RC, Gill GM. Estramustine phosphate compared with diethylstilbestrol. A randomized, double blind, crossover trial for stage D prostate cancer. Am J Clin Oncol (CCT) 9:341–351, 1986.

    Google Scholar 

  60. Smith PH, Suciu S, Robinson MRG, et al. A comparison of the effect of diethylstilbestrol with low dose estramustine phosphate in the treatment of advanced prostatic cancer: final analysis of a phase III trial of the European Organization for Research on Treatment of Cancer. J Urol 136:619–623, 1986.

    PubMed  CAS  Google Scholar 

  61. DeVoogt HJ, Smith PH, Pavone-Macaluso M, et al. Cardiovascular side effects of diethylstilbestrol, cyproterone acetate, medroxyprogesterone acetate and estramustine phosphate used for the treatment of advanced prostatic cancer: results from European Organization for Research on Treatment of Cancer Trials 30761 and 30762. J Urol 135:303–307, 1986.

    PubMed  Google Scholar 

  62. Johansson JE, Andersson SO, Beckman KW, et al. Clinical evaluation of flutamide and estramustine as initial treatment of metastatic carcinoma of prostate. Urology 29:55–59, 1987.

    Article  PubMed  CAS  Google Scholar 

  63. Flamm J, Fischer M. Complete androgen blockade (orchiectomy + Flutamide) versus androgen blockade with cytostatic (orchiectomy + estramustine) in the treatment of virginal advanced prostate cancer. Wien Klin Wochenschr 100:589–592, 1988.

    PubMed  CAS  Google Scholar 

  64. Roessler W, Hinke A, Wieland WF. Experience in advanced prostatic cancer: orchiectomy and Flutamide versus orchiectomy and estramustine phosphate. Urology 43(Suppl 2): 57–60, 1994.

    Article  PubMed  CAS  Google Scholar 

  65. Kühn M, Weissbach L, Hinke A. Primary therapy of metastasized prostate carcinoma with depot gonadotropin releasing hormone analogue goserelin vs. estramustine phosphate. Urology 43(Suppl 2): 61–67, 1994.

    Article  PubMed  Google Scholar 

  66. Van Poppel H, Werbrouck PW, Baert L. Effect of estramustine phosphate on free androgens. A comparative study of the effect of orchiectomy and estramustine phosphate on free androgens in patients with prostatic cancer. Acta Urol Belg 58:89–95, 1990.

    PubMed  Google Scholar 

  67. Gunnarsson PO, Davidsson T, Andersson SB, et al. Impairment of estramustine phosphate absorption by concurrent intake of milk and food. Eur J Clin Pharmacol 38:189–193, 1990.

    Article  PubMed  CAS  Google Scholar 

  68. Benson RC Jr. Role of estramustine phosphate in the treatment of prostate cancer. In Schaefers H (ed), Estracyt. Scientific Edition 2: Utrecht, 1988, pp 35–64.

    Google Scholar 

  69. Soloway MS, DeKernion JB, Gibbons RP, et al. Comparison of estramustine phosphate and vincristine alone or in combination for patients with advanced, hormone refractory, previously irradiated carcinoma of the prostate. J Urol 125:664–667, 1981.

    PubMed  CAS  Google Scholar 

  70. Toulouse I, Jung JL, Bittard M. Interet de l’estramustine phosphate dans de traitement des adenocarcinomes prostatiques oestrogeno-resistants. J d’Urologie (Paris) 90:27–33, 1984.

    CAS  Google Scholar 

  71. DeKernion JN, Murphy GP, Priore R. Comparison of Flutamide and Emcyt in hormone refractory metastatic prostatic cancer. Urology 31:312–317, 1988.

    Article  PubMed  Google Scholar 

  72. Newling DWW, Fossa SD, Turin VW, et al. Mitomycin C versus estramustine in the treatment of hormone resistant metastatic prostatic cancer: the final analysis of the European Organization for Reasearch and Treatment of Cancer Genitourinary Group prospective randomized phase III study (30865). J Urol 150:1840–1844, 1993.

    PubMed  CAS  Google Scholar 

  73. Benson RC. Estramustine phosphate: clinical experience in the United States. In UroOncology Update, Experimental and Therapeutic Progress in Prostate Cancer, 1988, pp 19–22.

    Google Scholar 

  74. Veronesi A, Dal-Bo V, Lo-Re G, et al. Mitomycin C treatment of advanced hormoneresistant prostatic carcinoma: a phase II study. Cancer Chemother Pharmacol 23:115–116, 1989.

    Article  PubMed  CAS  Google Scholar 

  75. Murphy GP, Beckley S, Brady MF, et al. Treatment of newly diagnosed metastatic prostate cancer patients with chemotherapy agents in combination with hormones versus hormones alone. Cancer 51:1264–1272, 1983.

    Article  PubMed  CAS  Google Scholar 

  76. Amato RJ, Logothetis CJ, Dexeus FH, et al. Preliminary results of a phase II trial of estramustine (Emcyt) and vinblastine (VLB) for patients with progressive hormone refractory prostate carcinoma (HRPC). Proc AACR 32:186, 1991.

    Google Scholar 

  77. Seidman AD, Scher HI, Petrylak D, et al. Estramustine and vinblastine: use of prostate specific antigen as a clinical trial end point for hormone refractory prostatic cancer. J Urol 147:931–934, 1992.

    PubMed  CAS  Google Scholar 

  78. Hudes GR, Greenberg R, Krigel RL, et al. Phase II study of estramustine and vinblastine, two microtubule inhibitors, in hormone-refractory prostate cancer. J Clin Oncol 10: 1754–1761, 1992.

    PubMed  CAS  Google Scholar 

  79. Amato R, Logothetis C, Sella A, et al. Preliminary results of a phase II trial of estramustine (Emcyt), vinblastine (VLB) and mitomycin C (MMC) for patients (pts) with progressive androgen independent prostate carcinoma (AIPCa). Proc AACR 34:203,1993.

    Google Scholar 

  80. Lo Re G, Veronesi A, DalBo V, et al. Combination chemotherapy in ‘nonelderly’ patients with hormone refractory prostatic carcinoma. Proc ASCO 11:211, 1992.

    Google Scholar 

  81. Pienta KJ, Redman BG, Hussain M, et al. Phase II evaluation of oral estramustine and oral etoposide in hormone-refractory adenocarcinoma of the prostate. J Clin Oncol 12: 2005–2012, 1994.

    PubMed  CAS  Google Scholar 

  82. Ferno M, Borg A, Ingvar C, et al. Estrogen receptor and binding site for estramustine in metastatic malignant melanoma. Anticancer Res 7:741–743, 1987.

    PubMed  CAS  Google Scholar 

  83. Jönsson PE, Ingvar C, Ferno M, et al. Phase II study of estramustine phosphate (Estracyt) in patients with metastatic melanoma. Eur J Cancer Clin Oncol 24:413–415, 1988.

    Article  PubMed  Google Scholar 

  84. Karakousis CP, Emrich LJ. Adjuvant treatment of malignant melanoma with DTIC + estracyt or BCG. J Surg Oncol 36:235–238, 1987.

    Article  PubMed  CAS  Google Scholar 

  85. Harrison JD, Watson S, Ellis IO, et al. A study on the effects of estradiol and estramustine on gastrointestinal cell lines. Eur J Surg Oncol 16:116–120, 1990.

    PubMed  CAS  Google Scholar 

  86. Björk P, Jönsson U, Andren-Sandberg A. Binding sites for the cytotoxic metabolites of estramustine phosphate (Estracyt) in rat and human pancreas that are distinct from pancreatic estrogen-binding protein. Pancreas 6:77–89, 1991.

    Article  PubMed  Google Scholar 

  87. Alexander NC, Hancock AK, Masood MB, et al. Estracyt in advanced carcinoma of the breast: a phase II study. Clin Radiol 30:139–147, 1979.

    Article  PubMed  CAS  Google Scholar 

  88. Fakih M, Yagoda A, Pienta KJ. Colchicine and estramustine as combination chemotherapy in preclinical studies for hormone resistant prostate cancer. Proc AACR 85:326, 1994.

    Google Scholar 

  89. Pienta KJ, Meyer L. Treatment and prevention of prostate cancer. Proc AACR 85:678, 1994.

    Google Scholar 

  90. Hudes G, Nathan F, Chapman A, et al. Combined Antimicrotubule Therapy of Metastatic Prostate Cancer with 96-HR Paclitaxel (P) and Estramustine (EM); Activity in Hormone-Refractory Disease (HRPC). Proc ASCO 14:237, 1995.

    Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1995 Springer Science+Business Media New York

About this chapter

Cite this chapter

Kreis, W. (1995). Estramustine revisited. In: Muggia, F.M. (eds) Concepts, Mechanisms, and New Targets for Chemotherapy. Cancer Treatment and Research, vol 78. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-2007-8_8

Download citation

  • DOI: https://doi.org/10.1007/978-1-4615-2007-8_8

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-5829-9

  • Online ISBN: 978-1-4615-2007-8

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics