Efficacy of treatment with a GnRH antagonist in prostate cancer patients previously treated with a GnRH agonist

Ezaki, Toshihiko; Kosaka, Takeo; Mizuno, Ryuichi; Shinojima, Toshiaki; Kikuchi, Eiji; Miyajima, Akira; Oya, Mototsugu

doi:10.1007/s00280-015-2798-4

Cited by 4 publications

(8 citation statements)

References 11 publications

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“…Some studies determined that overall, there was no statistically significant difference between PSA levels before and after the switch. 10,12 These studies also found no correlation between initial PSA levels and response to the switch. Furthermore, out of 24 patients with PSA response in the studies that reported follow-up data beyond the evaluation 3 months after the switch, 16 had no PSA progression during follow-up (mean[range] : 9.5 months [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]), 7 had PSA progression (4.83 months [4][5][6][7]) and 2 switched therapies or withdrew from the trial.…”

Section: Cuaj -Original Researchmentioning

confidence: 84%

“…10,12 These studies also found no correlation between initial PSA levels and response to the switch. Furthermore, out of 24 patients with PSA response in the studies that reported follow-up data beyond the evaluation 3 months after the switch, 16 had no PSA progression during follow-up (mean[range] : 9.5 months [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]), 7 had PSA progression (4.83 months [4][5][6][7]) and 2 switched therapies or withdrew from the trial. 11,[14][15][16] Changes in testosterone levels following the switch to degarelix could not be quantitatively assessed due to lack of sufficient individual data for analysis.…”

Section: Cuaj -Original Researchmentioning

confidence: 84%

“…Patients who had undergone chemotherapy before the switch were included in one study. 10 Some studies comprised only or included patients treated with complete androgen blockade (ADT plus an anti-androgen) [11][12][13][14][15] while others included patients with ADT alone before the switch. 16,17 However, all published studies described excluding the possibility of antiandrogen withdrawal syndrome.…”

Section: Resultsmentioning

confidence: 99%

“…On the other hand, several studies found that FSH level decreased further in many patients after the switch, although decreases were not necessarily associated with a PSA response. 10,11,14…”

Section: Cuaj -Original Researchmentioning

confidence: 99%

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Switching from a GnRH agonist to a GnRH antagonist in prostate cancer patients: A systematic review and meta-analysis

Atchia

Wallis

Fleshner

et al. 2019

CUAJ

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Introduction: We sought to address whether there are clinical responses when patients who are failing gonadotropin-releasing hormone (GnRH) agonist therapy are switched to degarelix. Androgen-deprivation therapy remains the backbone of treatment for disseminated prostate cancer and may be achieved with orchiectomy, GnRH agonists, or degarelix, a GnRH antagonist. Methods: To perform a systematic review and meta-analysis, a search of the BIOSIS Previews, Embase, International Pharmaceutical Abstracts, MEDLINE, and Google Scholar databases was performed using key terms. Quantitative meta-analysis was performed to provide a pooled estimate of prostate-specific antigen (PSA) response at three months. Results: Thirteen studies were identified, eight of which were included in the qualitative and quantitative analyses. Patient characteristics were broadly similar between the studies. Out of 155 patients across all included studies, 20 had stable PSA after the switch (12.9%), 14 had between 10‒30% decrease in PSA (9.0%), three had between 30‒50% decrease (1.9%), and 13 had more than 50% decrease (8.4%). Random effects meta-analysis of these data demonstrated a pooled response rate of 27.75 (95% confidence interval 18.9‒36.5%; I2=7.9%). Changes in testosterone levels following the switch could not be quantitatively assessed due to lack of sufficient data. Conclusions: Our results suggest that a switch to GnRH antagonist following progression on a GnRH agonist may result in a stable or decreased PSA at three months in about 30% of patients. This information should be considered among the potential options to discuss with patients with a rising PSA on GnRH agonist therapy.

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Section: Cuaj -Original Researchmentioning

confidence: 84%

Section: Cuaj -Original Researchmentioning

confidence: 84%

Section: Resultsmentioning

confidence: 99%

Section: Cuaj -Original Researchmentioning

confidence: 99%

See 2 more Smart Citations

Switching from a GnRH agonist to a GnRH antagonist in prostate cancer patients: A systematic review and meta-analysis

Atchia

Wallis

Fleshner

et al. 2019

CUAJ

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“… 30 – 32 Previous studies suggested that repeated degarelix injections might provoke skin reactions at the injection site, particularly at the first injection. 10 – 12 It has been estimated that injection site reactions occur in over 40% of degarelix-treated patients 11 and that they eventually become serious enough to cause discontinuation of therapy. In the current study, we also observed that large numbers of patients developed injection site reactions of varying severity, but they only caused discontinuation of degarelix therapy in four cases.…”

Section: Discussionmentioning

confidence: 99%

Degarelix treatment is compatible with diabetes and antithrombotic therapy in patients with prostate cancer

Tokiwa

Shimmura

Nomura

et al. 2017

RRU

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IntroductionTherapeutically induced androgen deficiency (AD) is a standard treatment for patients with prostate cancer, but it is often associated with various adverse effects (AEs) that may lead to discontinuation. Some AEs may depend on the patient’s health condition, while others may be due to complications of the drug delivery method. Degarelix is a gonadotropin-releasing hormone (GnRH) antagonist widely used for the treatment of androgen-dependent prostate cancer. This study aimed to ascertain the following: 1) the compatibility of degarelix treatment with diabetes and 2) any specific causal associations of degarelix injections with increased blood clotting and antithrombotic therapy requirements.Patients and methodsThe medical records of 162 patients with prostate cancer who had undergone degarelix treatment were retrospectively examined. The association of a medical history of diabetes and anticoagulant co-treatment with degarelix treatment discontinuation was analyzed statistically.ResultsRapid and significant decreases in prostate-specific antigen (PSA) levels during the course of degarelix treatment were detected for patients with prostate cancer regardless of clinical state. During the 27 months of treatment, 68 subjects (48%) ceased degarelix treatment, owing to several reasons, mainly financial issues. Among these subjects, 19 had diabetes, while 35 were treated with antithrombotics. Extensive statistical analysis indicated that there were no causal associations between degarelix treatment discontinuation and preexisting diabetes or antithrombotic therapy.ConclusionOur study suggests that preexisting diabetes and antithrombotic therapy were not significant factors for the discontinuation of degarelix treatment in patients with prostate cancer.

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Effectiveness of GnRH Antagonists and Agonists in Patients with Hormone-Sensitive Prostate Cancer: A Retrospective Study

Liu

Yang

Zeng

et al. 2022

Applied Bionics and Biomechanics

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Objective. To assess the effectiveness of gonadotropin-releasing hormone (GnRH) antagonists and agonists in the treatment of patients with hormone-sensitive prostate cancer (HSPC), thus providing valid data support for their clinical treatment. Methods. We collected 52 and 65 HSPC patients treated with GnRH antagonists and agonists, respectively, in Tongji Hospital, Tongji Medical College of HUST between May 2019 and April 2021. Prostate-specific antigen (PSA) levels before and after treatment were recorded and analyzed. Further, univariate and multivariate logistic regressions were used to analyze the influencing factors of PSA control rate in HSPC patients. Results. In patients receiving antagonist, the control rate of prostate-specific antigen (PSA) was 54.28% and 88% without and with abiraterone, respectively, and 47.91% and 72% in patients treated using agonist without and with abiraterone. In 32 pairs of patients obtained via propensity score matching, the PSA control rates were 84.38% and 53.13% for those receiving antagonists and agonists, respectively, and 66.67% and 50% for those without abiraterone, respectively. In addition, univariate logistic regression analysis showed that the type of androgen deprivation therapy (ADT) drugs and combined use of abiraterone had a significant effect on the control rate of PSA. Further multivariate logistic regression revealed that GnRH antagonists in ADT drugs were risk factors for PSA control rate. Conclusion. The PSA control rate of HSPC patients treated with GnRH antagonist is significantly higher than that of the agonist group, and the use of GnRH antagonist is an independent predictor of PSA control rate.

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Efficacy of treatment with a GnRH antagonist in prostate cancer patients previously treated with a GnRH agonist

Abstract: Switching from GnRH agonist to GnRH antagonist therapy was effective for some prostate cancer patients with PSA failure. The small number of prior treatment lines for prostate cancer before the switch was significantly associated with a good PSA response.

Cited by 4 publications

References 11 publications

Switching from a GnRH agonist to a GnRH antagonist in prostate cancer patients: A systematic review and meta-analysis

Switching from a GnRH agonist to a GnRH antagonist in prostate cancer patients: A systematic review and meta-analysis

Degarelix treatment is compatible with diabetes and antithrombotic therapy in patients with prostate cancer

Effectiveness of GnRH Antagonists and Agonists in Patients with Hormone-Sensitive Prostate Cancer: A Retrospective Study

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