Gonadotropin‐releasing hormone: An update review of the antagonists versus agonists
Tóm tắt
Gonadotropin‐releasing hormone agonists and antagonists provide androgen‐deprivation therapy for prostate cancer. Unlike agonists, gonadotropin‐releasing hormone antagonists have a direct mode of action to block pituitary gonadotropin‐releasing hormone receptors. There are two licensed gonadotropin‐releasing hormone antagonists, degarelix and abarelix. Of these, degarelix is the more extensively studied and has been documented to be more effective than the well‐established, first‐line agonist, leuprolide, in terms of substantially faster onset of castration, faster suppression of prostate‐specific antigen, no risk for testosterone surge or clinical flare, and improved prostate‐specific antigen progression‐free survival, suggesting a delay in castration resistance. Other than minor injection‐site reactions, degarelix is generally well tolerated, without systemic allergic reactions and with most adverse events consistent with androgen suppression or the underlying condition. In conclusion, degarelix provides a rational, first‐line androgen‐deprivation therapy suitable for the treatment of prostate cancer, with faster onset of castration than with agonists, and no testosterone surge. Furthermore, data suggest that degarelix improves disease control compared with leuprolide, and might delay the onset of castration‐resistant disease. In view of these clinical benefits and the lack of need for concomitant anti‐androgen treatment, gonadotropin‐releasing hormone antagonists might replace gonadotropin‐releasing hormone agonists as first‐line androgen‐deprivation therapy in the future.
Từ khóa
Tài liệu tham khảo
Thompson IM, 2001, Flare associated with LHRH‐agonist therapy, Rev. Urol., 3, S10
Hotte SJ, 2010, Current management of castrate‐resistant prostate cancer, Curr. Oncol., 17, S72, 10.3747/co.v17i0.718
HeidenreichA BollaM JoniauSet al.2011.Guidelines on prostate cancer. [Cited 8 August 2011.] Available from URL:http://www.uroweb.org/gls/pdf/08_Prostate_Cancer.pdf
Guyton AC, 1991, Textbook of Medical Physiology, 885
Selvaggi F, 2001, Comparison of abarelix depot (A‐D) and goserelin (G) plus bicalutamide (B) in advanced prostate cancer: results of a multicentre, open‐label, randomised, phase III study, Eur. Urol., 39, 78
Plenaxis Drug Information.2011. [Cited 8 August 2011]. Available from URL:http://www.rxlist.com/plenaxis‐drug.htm#
US Food and Drug Administration.2010.GnRH agonists: label change – increased risk of diabetes and cardiovascular disease (update). [Cited 8 August 2011]. Available from URL:http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm230359.htm
WaknineY.2005.International approvals: plenaxis tostrex troxatyl. [Cited 8 August 2011]. Available from URL:http://www.medscape.com/viewarticle/513892
Specialty European Pharma.2011.Your partner in urology. [Cited 8 August 2011]. Available from URL:http://www.specialityeuropeanpharma.com
AndersonJ Al‐AliG WirthMet al.Improved relief of lower urinary tract symptoms (LUTS) with a gonadotrophin‐releasing hormone (GnRH) blocker compared with an agonist + antiandrogen (AA) in an open‐label randomised study (CS28). Abstract presented at the European Multidisciplinary Meeting on Urological Cancers Barcelona Spain 2011.