Class: Chemotherapy

Generic Name: Estramustine (es-truh-MUS-teen)
Trade Name: Emcyt®

For which conditions is this drug approved? Estramustine is FDA approved for the treatment of prostate cancer that has spread to distant sites in the body or is progressing following previous therapies. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Estramustine is a chemotherapy agent combined with an estrogen derivative. The chemotherapy component of estramustine inhibits proper function of microtubules, which are components of a cell that provide structural framework for replication and growth. The estrogen derivative of estramustine reduces levels of male hormones in the body. Prostate cancer cells are stimulated to grow from male hormones.  The inhibition of proper microtubule function, as well as the lowering of levels of growth-stimulatory male hormones in the body produced by estramustine ultimately stops cancer cells from replicating and causes cellular death.

How is estramustine typically given (administered)? Estramustine comes in the form of a capsule and is taken orally. It is recommended that estramustine be taken either 1 hour before meals on an empty stomach, or 2 hours after meals with a glass of water.

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with estramustine.  Typically, blood will be drawn to monitor functions of some organ systems, such as the kidneys or liver.  Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy.  Patients will also be monitored for blood clots or complications of blood clots. If patients experience swelling, pain or redness of one leg and not the other, difficulty breathing, severe headache or vision changes, they should contact their healthcare provider immediately.

What are the common (occur in 30% or more of patients) side effects of treatment with estramustine?

• Breast tenderness or enlargement
• Decrease in sexual drive
• Impotence

What are the less common (occur in 10% to 29% of patients) side effects of treatment with estramustine?

• Difficulty breathing
• Abnormalities in liver function levels, as determined by blood tests
• Impaired circulation
• Heart disease or changes in function
• Blood clots
• Decrease levels of platelets – increases risk of bleeding
• Leg cramps
• Nausea and vomiting
• Diarrhea
• Flatulence
• Swelling of ankles, feet, hands or face

This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.

Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• Eat small meals frequently to help alleviate nausea.

Are there any special precautions patients should be aware of before starting treatment?

• Calcium-containing foods (milk, milk products, or antacids) may inhibit optimal absorption of estramustine and should not be taken with estramustine. Patients should speak with their physician about timing of ingesting calcium-containing compounds and taking estramustine.
• Estramustine must be kept refrigerated.
• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician if they have thromboembolic disorders are a history of stroke.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• If an oral dose is missed, do not double up on doses.  Patients should contact their doctor in this event.
• Keep tablets out of reach of children and return to the pharmacy for safe disposal if treatment is terminated.

When should patients notify their physician?

• Chest pain
• Difficulty breathing
• Swelling, pain, redness of one extremity and not the other
• Weakness or numbness in arms or legs
• Sudden pain or cramping in legs
• Sudden headache, blurred vision
• Persistent and severe nausea
• Persistent diarrhea
• Swelling of ankles, feet, or face
• Sudden weight gain
• Yellowing of the skin or eyes

What is a package insert? A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers.  A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

Copyright © 2010 CancerConnect Last updated 07/10.

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