Ketoconazole and Flutamide in the Treatment of Disse-
minated Intravascular Clotting from Prostate Cancer :
A Case Report and Review
SURACHA T CHAKRAPEE-SIRISUK, M.D.*,
SUKON VISUDHIPHAN, M.D.***,
VI CHIEN SRIMUNINNIMIT, M.D.*,
KANCHANA AMORNPICHETKUL, M.D.**,
TUMTIP SANGRUCHI, M.D.**,
PAIROJ SINLARAT, M.D.*
Affiliation : * Division of Medical Oncology, Department of Medicine,
** Department of Pathology,
*** Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University,
Bangkok 10700, Thailand.
AbstractDisseminated intravascular clotting (DIC) is a well-recognized complication of malignancy.
Prostatic cancer can produce chronic DIC as well as acute severe DIC. Treatment of DIC are general
supportive measures including heparin, transfusion of blood, platelets and clotting factors, but the
most important aspect is correction of underlying malignant diseases i.e. cancer of the prostate
gland.
For metastatic prostatic cancer presenting with an emergency oncologic condition, the
treatment of choice is surgical orchiectomy, but surgery may not be possible in the presence of
severe DIC. Ketoconazole and Flutamidet are drugs with different mechanisms for hormonal
manipulation of this cancer. Due to severe DIC, we combined both drugs trying to put maximum
therapeutic effect on this life threatening profound DIC patient.
Keywords : Ketoconazole, Flutamide, DIC, Prostate Cancer
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