Fosfestrol

Fosfestrol, sold under the brand name Honvan and also known as diethylstilbestrol diphosphate (DESDP), is an estrogen medication which is used in the treatment of prostate cancer in men.[1][2][3] It is given by slow intravenous infusion once per day to once per week or by mouth once per day.[3][2]

Fosfestrol
Clinical data
Trade namesHonvan, others
Other namesDiethylstilbestrol diphosphate; Stilbestrol diphosphate; DESDP; DESP; DES-DP; DES-P
AHFS/Drugs.comInternational Drug Names
Routes of
administration		Intravenous, by mouth
Drug classNonsteroidal estrogen; Estrogen ester
ATC code
Legal status
Legal status
  • In general: ℞ (Prescription only)
Identifiers
  • [4-[4-(4-phosphonooxyphenyl)hex-3-en-3-yl]phenoxy]phosphonic acid
CAS Number
PubChem CID
ChemSpider
UNII
KEGG
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.007.573
Chemical and physical data
FormulaC18H22O8P2
Molar mass428.314 g·mol−1
3D model (JSmol)
  • O=P(Oc1ccc(cc1)\C(=C(\c2ccc(OP(=O)(O)O)cc2)CC)CC)(O)O
  • InChI=1S/C18H22O8P2/c1-3-17(13-5-9-15(10-6-13)25-27(19,20)21)18(4-2)14-7-11-16(12-8-14)26-28(22,23)24/h5-12H,3-4H2,1-2H3,(H2,19,20,21)(H2,22,23,24)/b18-17+ checkY
  • Key:NLORYLAYLIXTID-ISLYRVAYSA-N checkY
  (verify)

Side effects of fosfestrol include nausea and vomiting, cardiovascular complications, blood clots, edema, and genital skin reactions, among others.[2] Fosfestrol is an estrogen, and hence is an agonist of the estrogen receptor, the biological target of estrogens like estradiol.[2][1][4] It acts as a prodrug of diethylstilbestrol.[2][1][5]

Fosfestrol was patented in 1941 and was introduced for medical use in 1955.[6] It was previously marketed widely throughout the world, but now remains available in only a few countries.[7][8][6][3]

Medical uses

Fosfestrol is used as a form of high-dose estrogen therapy in the treatment of castration-resistant prostate cancer.[2] It is added once progression of metastases has occurred following therapy with other interventions such orchiectomy, gonadotropin-releasing hormone modulators, and nonsteroidal antiandrogens.[2] Fosfestrol has also been used to prevent the testosterone flare at the start of gonadotropin-releasing hormone agonist therapy in men with prostate cancer.[9]

Fosfestrol sodium is given at a dosage of 600 to 1200 mg/day by slow intravenous infusion over a period of 1 hour for a treatment duration of 5 to 10 days in men with prostate cancer.[3][2] Following this, it is given at a dose of 300 mg/day for 10 to 20 days.[3] Maintenance doses of fosfestrol sodium of 300 to 600 mg may be given four times per week.[3] This may be gradually reduced to one 300 to 600-mg dose per week over a period of several months.[3]

Fosfestrol sodium is also used to a lesser extent by oral administration initially at a dosage of 360 to 480 mg three times per day in the treatment of prostate cancer.[3][2] Maintenance doses of 120 to 240 mg three times per day may be used and can be gradually reduced to 240 mg/day.[3][2]

Estrogen dosages for prostate cancer
Route/formEstrogenDosage
OralEstradiol1–2 mg 3x/day
Conjugated estrogens1.25–2.5 mg 3x/day
Ethinylestradiol0.15–3 mg/day
Ethinylestradiol sulfonate1–2 mg 1x/week
Diethylstilbestrol1–3 mg/day
Dienestrol5 mg/day
Hexestrol5 mg/day
Fosfestrol100–480 mg 1–3x/day
Chlorotrianisene12–48 mg/day
Quadrosilan900 mg/day
Estramustine phosphate140–1400 mg/day
Transdermal patchEstradiol2–6x 100 μg/day
Scrotal: 1x 100 μg/day
IMTooltip Intramuscular or SC injectionEstradiol benzoate1.66 mg 3x/week
Estradiol dipropionate5 mg 1x/week
Estradiol valerate10–40 mg 1x/1–2 weeks
Estradiol undecylate100 mg 1x/4 weeks
Polyestradiol phosphateAlone: 160–320 mg 1x/4 weeks
With oral EE: 40–80 mg 1x/4 weeks
Estrone2–4 mg 2–3x/week
IV injectionFosfestrol300–1200 mg 1–7x/week
Estramustine phosphate240–450 mg/day
Note: Dosages are not necessarily equivalent. Sources: See template.

Available forms

Fosfestrol is available in the form of solutions for intravenous administration and tablets for oral administration.[10]

Side effects

Side effects of fosfestrol include nausea and vomiting in 80% of patients (with 1 in 25 cases, or 4%, resulting in death), cardiovascular complications (18% with fosfestrol plus adriamycin relative to 2% with adriamycin alone) such as thrombosis (2 in 25 cases, or 8%), edema (44% requiring diuretic therapy), and skin reactions such as burning, itching, or pain in the genital area (40%).[2][1] In addition, weight gain, feminization, and gynecomastia may occur.[1]

Pharmacology

Pharmacodynamics
Testosterone levels with no treatment and with various estrogens in men with prostate cancer.[11] Determinations were made with an early radioimmunoassay (RIA).[11] Source was Shearer et al. (1973).[11]

Fosfestrol is an estrogen, or an agonist of the estrogen receptors.[2][1][4] It is inactive itself and acts as a prodrug of diethylstilbestrol.[2][1][5] Similarly to diethylstilbestrol, fosfestrol has powerful antigonadotropic effects and strongly suppresses testosterone levels in men.[2][1][12][13] It decreases testosterone levels into the castrate range within 12 hours of the initiation of therapy.[1] Fosfestrol may also act by other mechanisms, such as via direct cytotoxic effects in the prostate gland.[2][1]

Pharmacokinetics

The pharmacokinetics of fosfestrol have been studied.[2][14][1]

Chemistry
See also: Nonsteroidal estrogen, Estrogen ester, and List of estrogen esters § Diethylstilbestrol esters

Fosfestrol is a synthetic nonsteroidal estrogen of the stilbestrol group.[15][3] It is an estrogen ester; specifically, it is the diphosphate ester of diethylstilbestrol.[15][3]

Fosfestrol is provided both as the free base and as a tetrasodium salt.[2][3] In terms of dose equivalence, 300 mg anhydrous fosfestrol sodium is equal to about 250 mg fosfestrol.[3]

A polymer of fosfestrol, polydiethylstilbestrol phosphate, was developed as a long-acting estrogen for potential use in veterinary medicine, but was never marketed.[16][17][18][19][20][21]

History

Fosfestrol was first patented in 1941 and was mentioned in the literature by Huggins.[6][22] Conjugated estrogens and diethylstilbestrol sulfate, which are water-soluble estrogens, were first reported to be effective in the treatment of prostate cancer via intravenous administration in 1952.[23][22] Starting in October 1952, Flocks and colleagues studied intravenous fosfestrol in the treatment of prostate cancer, publishing their findings in 1955.[22] Fosfestrol was first introduced for medical use in 1955 under the brand names Stilphostrol and ST 52 in the United States and France, respectively.[6]

Society and culture

Generic names

Fosfestrol is the generic name of the drug and its INNTooltip International Nonproprietary Name, BANTooltip British Approved Name, and JANTooltip Japanese Accepted Name, while diethylstilbestrol diphosphate is its USANTooltip United States Adopted Name and fosfestrolo is its DCITTooltip Denominazione Comune Italiana.[15][7][8][3] It is also known as stilbestrol diphosphate.[15][7][8] Fosfestrol sodium is its INNMTooltip International Nonproprietary Name and BANMTooltip British Approved Name.[15][7][8][3]

Brand names

Brand names of fosfestrol include Cytonal, Difostilben, Honovan, Honvan, Honvol, Honvon, Fosfostilben, Fostrolin, ST 52, Stilbetin, Stilbol, Stilbostatin, Stilphostrol, and Vagestrol, among others.[15][7][8][6]

Availability

Fosfestrol has been marketed widely throughout the world, including in the United States, Canada, Europe, Asia, Latin America, and South Africa, among other areas of the world.[7][8][3][6] However, today, it appears to remain available only in a few countries, including Bangladesh, Egypt, India, Oman, and Tunisia.[8][3]

See also

References
  1. Droz JP, Kattan J, Bonnay M, Chraibi Y, Bekradda M, Culine S (February 1993). "High-dose continuous-infusion fosfestrol in hormone-resistant prostate cancer". Cancer. 71 (3 Suppl): 1123–1130. doi:10.1002/1097-0142(19930201)71:3+<1123::AID-CNCR2820711434>3.0.CO;2-T. PMID 8428334. S2CID 23078614.
  2. von Bruchhausen F, Dannhardt G, Ebel S, Frahm AW, Hackenthal E, Holzgrabe U (2 July 2013). Hagers Handbuch der Pharmazeutischen Praxis: Band 8: Stoffe E-O. Springer-Verlag. pp. 301–. ISBN 978-3-642-57994-3.
  3. Sweetman SC, ed. (2009). "Sex hormones and their modulators". Martindale: The Complete Drug Reference (36th ed.). London: Pharmaceutical Press. pp. 2104–2105. ISBN 978-0-85369-840-1.
  4. Oettel M (1999). "Estrogens and Antiestrogens in the Male". In Oettel M, Schillinger E (eds.). Estrogens and Antiestrogens II: Pharmacology and Clinical Application of Estrogens and Antiestrogen. Handbook of Experimental Pharmacology. Vol. 135 / 2. Springer Science & Business Media. pp. 505–571. doi:10.1007/978-3-642-60107-1_25. ISBN 978-3-642-60107-1. ISSN 0171-2004.
  5. Urotext (1 January 2001). Urotext-Luts: Urology. Urotext. pp. 386–. ISBN 978-1-903737-03-3.
  6. William Andrew Publishing (22 October 2013). Pharmaceutical Manufacturing Encyclopedia. Elsevier. pp. 1292–. ISBN 978-0-8155-1856-3.
  7. Index Nominum 2000: International Drug Directory. Taylor & Francis. January 2000. pp. 332–. ISBN 978-3-88763-075-1.
  8. "Fosfestrol - Drugs.com". Archived from the original on 2019-03-29. Retrieved 2019-03-29.
  9. Kotake T, Usami M, Akaza H, Koiso K, Homma Y, Kawabe K, et al. (November 1999). "Goserelin acetate with or without antiandrogen or estrogen in the treatment of patients with advanced prostate cancer: a multicenter, randomized, controlled trial in Japan. Zoladex Study Group". Japanese Journal of Clinical Oncology. 29 (11): 562–570. doi:10.1093/jjco/29.11.562. PMID 10678560.
  10. Fernandez M, Calix L (8 February 2006). Modell's Drugs in Current Use and New Drugs, 2006: 52nd Edition. Springer Publishing Company. pp. 206–. ISBN 978-0-8261-7097-2.
  11. Shearer RJ, Hendry WF, Sommerville IF, Fergusson JD (December 1973). "Plasma testosterone: an accurate monitor of hormone treatment in prostatic cancer". British Journal of Urology. 45 (6): 668–677. doi:10.1111/j.1464-410x.1973.tb12238.x. PMID 4359746.
  12. Kitahara S, Umeda H, Yano M, Koga F, Sumi S, Moriguchi H, et al. (October 1999). "Effects of intravenous administration of high dose-diethylstilbestrol diphosphate on serum hormonal levels in patients with hormone-refractory prostate cancer". Endocrine Journal. 46 (5): 659–664. doi:10.1507/endocrj.46.659. PMID 10670751.
  13. Tunn UW, Senge T, Neumann F (1981). "Effekt von Diäthylstilböstroldiphosphat auf die Serumkonzentration von Testosteron und Luteinisierungshormon beim M1-Prostatakarzinom". Verhandlungsbericht der Deutschen Gesellschaft für Urologie. Vol. 32. pp. 447–449. doi:10.1007/978-3-642-81706-9_133. ISBN 978-3-540-11017-0. ISSN 0070-413X.
  14. Oelschläger H, Rothley D, Dunzendorfer U (1988). "New Results on the Pharmacokinetics of Fosfestrol". Urologia Internationalis. 43 (1): 15–23. doi:10.1159/000281427. ISSN 1423-0399.
  15. Elks J (14 November 2014). The Dictionary of Drugs: Chemical Data: Chemical Data, Structures and Bibliographies. Springer. pp. 396–. ISBN 978-1-4757-2085-3.
  16. Diczfalusy E, Fernö H, Fex B, Högberg B, Kneip P (1959). "High Molecular Weight Enzyme Inhibitors. IV. Polymeric Phosphates of Synthetic Estrogens" (PDF). Acta Chem. Scand. 13 (5): 1011–1018. doi:10.3891/acta.chem.scand.13-1011.
  17. Bengtsson G, Ullberg S, Perklev T (August 1963). "Autoradiographic Distribution Studies after Administration of a Macromolecular Synthetic Oestrogen (14C-Polydiethylstilboestrol Phosphate)". Acta Endocrinologica. 43 (4): 571–580. doi:10.1530/acta.0.0430571. PMID 14059878.
  18. Perklev T (November 1964). "Distribution and Excretion of Radioactivity after Parenteral Administration of Radioactive Polydiethylstilbestrol Phosphate to Rats and a Cow". Proceedings of the Society for Experimental Biology and Medicine. 117 (2): 394–398. doi:10.3181/00379727-117-29590. PMID 14233451. S2CID 28242978.
  19. Perklev T, Gassner FX, Martin RP, Huseby RA, Shimoda W (1965). "Excretion of radioactivity by human subjects after ingestion of liver from cattle treated with labeled polydiethylstilbestrol phosphate". Proceedings of the Society for Experimental Biology and Medicine. 119 (4): 996–998. doi:10.3181/00379727-119-30359. PMID 5891085. S2CID 43341013.
  20. Perklev T, Gassner FX, Hopwood ML (September 1967). "Distribution and excretion of 14C-labeled polydiethylstilbestrol phosphate in a steer". Journal of Animal Science. 26 (5): 1094–1100. doi:10.2527/jas1967.2651094x. PMID 6077168.
  21. Loew FM (October 1972). "The veterinarian and intensive livestock production: humane considerations". The Canadian Veterinary Journal. 13 (10): 229–233. PMC 1695928. PMID 4562986.
  22. Flocks RH, Marberger H, Begley BJ, Prendergast LJ (October 1955). "Prostatic carcinoma: treatment of advanced cases with intravenous diethylstilbestrol diphosphate". The Journal of Urology. 74 (4): 549–551. doi:10.1016/S0022-5347(17)67313-0. PMID 13264317.
  23. Resnick MI, Thompson IM (2000). Advanced Therapy of Prostate Disease. PMPH-USA. pp. 381–. ISBN 978-1-55009-102-1.

Further reading
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