Hormonal Therapy: Difference between revisions
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*** Goserelin (Zoladex) 10.8mg SC q3 months | *** Goserelin (Zoladex) 10.8mg SC q3 months | ||
*** Leuprolide (Lupron) 22.5mg SC q3months | *** Leuprolide (Lupron) 22.5mg SC q3months | ||
* '''LHRH antagonists (-lix (Abarelix, Cetrorelix, Degarelix, Relogolix))''' | * '''<span style="color:#ff0000">LHRH antagonists (</span><span style="color:#0000ff">-lix</span><span style="color:#ff0000> (Abarelix, Cetrorelix, Degarelix, Relogolix))''' | ||
** '''Advantages of LHRH antagonists over agonists:''' | ** '''<span style="color:#ff0000">Advantages of LHRH antagonists over agonists:''' | ||
**# '''Does not require co-administration of an anti-androgen''' due to lack of LH surge from lack of agonist activity | **# '''<span style="color:#ff0000">Does not require co-administration of an anti-androgen''' due to lack of LH surge from lack of agonist activity | ||
**# '''Testosterone levels can drop very quickly (within 3 days)''' | **# '''<span style="color:#ff0000">Testosterone levels can drop very quickly (within 3 days)''' | ||
**#* '''May be preferred in hormonally naive patients in whom urgent castration is needed (impending spinal cord compression or severe bone pain)''' or in whom surgical castration is not appropriate | **#* '''May be preferred in hormonally naive patients in whom urgent castration is needed (impending spinal cord compression or severe bone pain)''' or in whom surgical castration is not appropriate | ||
**#* LHRH antagonists bind immediately and competitively to the LHRH receptors in the pituitary, reducing LH concentrations by 84% within 24 hours of administration and testosterone levels dropping quickly with 34.5%, 60.5%, and 98.1% of men chemically castrate at 2, 4, and 28 days, respectively. [With LHRH agonists, the LH surge can last up to 2 weeks so testosterone levels only decrease after that§] | **#* LHRH antagonists bind immediately and competitively to the LHRH receptors in the pituitary, reducing LH concentrations by 84% within 24 hours of administration and testosterone levels dropping quickly with 34.5%, 60.5%, and 98.1% of men chemically castrate at 2, 4, and 28 days, respectively. [With LHRH agonists, the LH surge can last up to 2 weeks so testosterone levels only decrease after that§] | ||
** In a phase III study, degarelix was compared to leuprolide: at 1 year of treatment degarelix was not inferior to leuprolide (Klotz et al, 2008) | ** In a phase III study, degarelix was compared to leuprolide: at 1 year of treatment degarelix was not inferior to leuprolide (Klotz et al, 2008) | ||
** '''HERO''' | ** '''<span style="color:#ff00ff">HERO''' | ||
*** Population: 930 patients with 1 of 3 clinical disease presentations: | *** Population: 930 patients with 1 of 3 clinical disease presentations: | ||
***# Evidence of biochemical (PSA) or clinical relapse after local primary intervention with curative intent | ***# Evidence of biochemical (PSA) or clinical relapse after local primary intervention with curative intent | ||