HONVAN IN HORMONE REFRACTORY CARCINOMA PROSTATE: USEFUL DRUG BUT UNDERUTILIZED

Honvan is Fosfesterole tetrasodium; is a synthetic oestrgogen based compound.Studies have suggested  its usage in localized advanced carcinoma prostate and metastatic carcinoma prostate including the hormone refractory ones.

Strangely Honvan is more effective in bulky abdominal diseases like lymphnodes causing obstructive ureteral events ; than bony metastases.

We in Ramayya Pramila Hospitals prefer Honvan therapy in obstructive ureter/ vessels due to metastatic carcinoma prostate.

 

 

Pathophysiology:

 

Carcinoma prostate is hormone dependent cancer. Medical or surgical castration is  best form of initial therapy in metastatic or advanced carcinoma prostate.

There are several ways of achieving androgen ablation.Honvan achieves androgen ablation by getting conversion into stilbesterol in body.

Due to oestrogen activity it has its inherent side effects like cardiovascular side effects: fluid retention, cardiac failure due to fluid overload, anasarca,deep vein thrombosis etc.It should be judicious given to people with existing cardiac problems and people prone to develop thrombosis.

The other annoying side effect is painful Gynecomastia.

 

Dosage:

 

The dosage is 120 mg thrice a day continuously followed by serum PSA and other essential hematological/ biochemical and imaging studies.

Many urologists/ oncologists first give intravenous honvan especially in acute conditions like bilateral ureteric obstruction for a period of six days followed by maintenance dosage of 120 mg thrice a day.

For example a patient come with acute renal failure: metastatic carcinoma prostate with anuria ....many people give combination of intravenous fosfesterol with steroids with reasonable success.

Although we prefer to do PCN in such conditions.

 

  

Non-interventional management of obstructive acute renal-failure in hormone-naïve prostate cancer.

Agarwal MM, Singh SK, Acharya NC, et al.Canadian Journal of Urology 2007.

 

This therapy is quite cost effective and has good response in many cases. We define major responders are the ones who have a fall of serum PSA levels for more than 50% .