Efficacy of triptorelin in lowering serum testosterone (sT) in patients with advanced prostate cancer.

Abstract

162 Background: Medical castration using gonadotropin-releasing hormone (GnRH) agonists is the mainstay of treatment for advanced prostate cancer. Achievement and maintenance of castrate serum testosterone (sT) levels <50 ng/dL (1.735 nmol/mL) has been the goal of therapy. However, patients are able to achieve and maintain sT levels <15 ng/dL after surgical castration (Oefelein M et al. J Urology 2000; 56: 1021-4). Some authors have suggested that 20 ng/dL should be the target threshold for medical castration(Perachino M et al. BJU Int 2010; 105: 648-51) but the clinical relevance of achieving such low sT levels (<20 ng/dL) remains unknown. Methods: The efficacy and safety of sustained-release triptorelin pamoate 22.5 mg 6-month formulation was recently evaluated in a 12-month (48-week), multicentre, open-label, phase III study in 120 patients with locally advanced or metastatic prostate cancer and/or increased prostate specific antigen (PSA) after failed local therapy. Initial results based on the standard castration level of 50 ng/dL were previously presented in comparison to triptorelin 1- and 3-month formulations (Lundström E et al. Clin Drug Investig 2009; 29: 757-65). We report the proportions of patients achieving sT levels of <20 ng/dL with the triptorelin pamoate 1-, 3- and 6-month formulations. Results: With the 6-month formulation, sT levels of <20 ng/dL were achieved in >90% of patients on Day 169 (6 months after first triptorelin injection) and on Day 337 (6 months after second injection; Table). Similar sT levels were achieved with triptorelin 1- and 3-month formulations in a phase III study over 9 months (Table). Conclusions: A high proportion of patients receiving the 6-month triptorelin formulation achieve sT levels <20 ng/dL. This compares favorably to the triptorelin 1- and 3-month formulations. [Table: see text] [Table: see text]

Factors predicting progression to castrate‐resistant prostate cancer in patients with advanced prostate cancer receiving long‐term androgen‐deprivation therapy

“…Androgen‐deprivation therapy (ADT), with GnRH agonists or antagonists is an established and well‐tolerated therapy for locally advanced or metastatic prostate cancer . The efficacy and tolerability of the GnRH agonist triptorelin (Decapeptyl ® , Ipsen, Paris, France) as a treatment for locally advanced or metastatic prostate cancer has been shown in many studies .…”

Practical differences between luteinizing hormone-releasing hormone agonists in prostate cancer: perspectives across the spectrum of care

“…22 Another retrospective analysis of two clinical trials showed that triptorelin acetate IM injections suppressed testosterone levels to <0.2 ng/ml in over 90% of patients at 6 and 9 months for the 1- and 3-month formulations, and at 6 and 12 months for the 6-month formulation. 30 There are no long-term data for testosterone suppression to <0.2 ng/ml with goserelin acetate formulations. However, a small Brazilian study reported that 55% of patients who received monthly injections of goserelin acetate achieved this castration level within 3 months.…”

An Update on Triptorelin: Current Thinking on Androgen Deprivation Therapy for Prostate Cancer

“…In addition to the standard castrate testosterone threshold of <50 ng/dl, the 1-, 3-, and 6-month formulations of triptorelin have been shown to achieve the most stringent definition of castration (i.e., serum testosterone <20 ng/dl) in >90% of patients at 6, 9, and 12 months post-IM injection [ 28 , 47 ]. Although this more stringent definition of castration has not been widely adopted, the EAU guidelines state that a <20 ng/dl cut-off would be more appropriate, as better results are observed with lower levels of testosterone compared to 50 ng/dl [ 3 ].…”