|Skeletal formula of estramustine|
|Ball-and-stick model of the estramustine molecule|
|Systematic (IUPAC) name|
|Licence data||US FDA:|
|Metabolism||Hepatic to estradiol and estrone|
|14px (what is this?)|
Estramustine (Emcyt, Estracit) is an antimicrotubule chemotherapy agent used to treat prostate cancer. It is a derivative of oestrogen (specifically, estradiol) with a nitrogen mustard-carbamate ester moiety. It has been withdrawn from a number of markets (Australia, Brazil, Ireland and Norway).
Estramustine is indicated, in the US, for the palliative treatment of metastatic and/or progressive prostate cancer. Whereas in the UK it is indicated for the treatment of unresponsive or relapsing prostate cancer.
- Breast tenderness and enlargement
Common (1-10% frequency):
- Blood clots and complications thereof (including stroke, heart attacks, pulmonary embolism and thrombophlebitis)
Rare (<0.1% frequency):
- Angiooedema, occurs most commonly when used in combination with ACE inhibitors.
Unlike other nitrogen mustards it seldom produces significant GI or haematologic toxicity such as myelosuppression, the major drug toxicity-related cause of drug discontinuation is thromboembolism (blood clots).
It is contraindicated when used in children, patients hypersensitive to estradiol or nitrogen mustards, those with peptic ulcer (an ulcer in the digestive tract), those with severely compromised liver function, those with weak heart muscle (also known as myocardial insufficiency) and those with thromboembolic disorders or complications related to fluid retention.
Oestrogen mimics like estramustine have been reported to increase the toxicity and therapeutic efficacy of tricyclic antidepressants like amitriptyline and imipramine. Dairy products and other products containing calcium, aluminium and magnesium have been reported to reduce the absorption of estramustine from the gastrointestinal tract hence reducing bioavailability. There may be an increased risk of angiooedema in those concurrently taking ACE inhibitors.
Mechanism of action
Its therapeutic actions are believed to be related to its ability to depolymerising the microtubules (which it achieves by binding to microtubule associated proteins), this arrests prostate cancer cells in the G2/M phase of the cell cycle. It is selectively taken up by prostate cells and hence produces minimal cytotoxic effects on healthy tissue.
Estramustine is delivered as an oral capsule. It is readily taken up from the gastrointestinal tract and then rapidly dephosphorylated from estramustine phosphate to estramustine. Estramustine is then partially oxidised to estromustine. Some estramustine and estromustine undergoes hydrolysis at the ester bond in the liver to form estradiol, estrone and normustine. Milk, calcium, aluminium and magnesium supplements may reduce bioavailability.
- "Emcyt (estramustine) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 8 February 2014.
- Sweetman, S, ed. (12 February 2013). "Estramustine Sodium Phosphate". Martindale: The Complete Drug Reference. London, UK: Pharmaceutical Press. Retrieved 8 February 2014.
- "Estracyt Capsules - Summary of Product Characteristics (SPC)". electronic Medicines Compendium. Pfizer Limited. 12 August 2013. Retrieved 8 February 2014.
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- Fizazi, K; Le Maitre, A; Hudes, G; Berry, WR; Kelly, WK; Eymard, JC; Logothetis, CJ; Pignon, JP; Michiels, S; Meta-analysis of Estramustine in Prostate Cancer (MECaP) Trialists' Collaborative, Group (November 2007). "Addition of estramustine to chemotherapy and survival of patients with castration-refractory prostate cancer: a meta-analysis of individual patient data.". The lancet oncology 8 (11): 994–1000. PMID 17942366. doi:10.1016/S1470-2045%2807%2970284-X.