Failure of a gonadotropin-releasing hormone analogue to lower serum testosterone in patients with prostate cancer

Matsuda, Tadashi; Hiura, Yoshihito; Oguchi, Naoki; Muguruma, Koei; Mizutani, Takashi; Kawakita, Mutsushi

doi:10.1016/s0090-4295(01)01542-4

Cited by 6 publications

(4 citation statements)

References 5 publications

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“…In the present study, some patients using leuprolide had a skin reaction, but there was no association between skin reaction and testosterone levels outside the castrate range (data not shown). [14] reported three patients who failed to achieve lower serum testosterone levels (their testosterone levels were 3.52-6.09 ng/mL) despite treatment with goserelin acetate. There might be several explanations, including a change in the LHRH receptor, and antibodies against the drug.…”

Section: Discussionmentioning

confidence: 99%

Equivalent and sufficient effects of leuprolide acetate and goserelin acetate to suppress serum testosterone levels in patients with prostate cancer

et al. 2008

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OBJECTIVETo compare the effects of leuprolide acetate and goserelin acetate for suppressing serum testosterone levels in Japanese patients with prostate cancer, as several recent studies suggested that serum testosterone is not always suppressed below the upper limit of the castration range in patients using luteinizing hormone‐releasing hormone (LH‐RH) agonists, especially leuprolide acetate.PATIENTS AND METHODSIn all, 232 patients with prostate cancer, whose serum testosterone levels were measured before and during treatment using a 1‐ or 3‐monthly formulation of leuprolide or goserelin, were enrolled in a retrospective study. The mean age of the patients was 69.8 years and the mean testosterone level before the LHRH treatment was 4.54 ng/mL. The patients had their testosterone levels assessed a mean (range) of 5.4 (1–35) times during the LHRH treatment. A castrate serum testosterone level was defined as ≤0.5 ng/mL.RESULTSThe mean maximum testosterone level during 1‐monthly leuprolide (40 patients), 3‐monthly leuprolide (68), 1‐monthly goserelin (50), or 3‐monthly goserelin (74) treatment was 0.22, 0.20, 0.19 and 0.20 ng/mL, respectively (not significant). Four patients, including two treated with 1‐monthly leuprolide, one with 3‐monthly leuprolide and one with 3‐monthly goserelin, had serum testosterone above the castrate level, with a maximum of 0.5–0.65 ng/mL. Three of these patients had elevated testosterone only once or twice during the follow‐up, and the remaining patient had serum testosterone fluctuating at 0.4–0.6 ng/mL throughout the follow‐up.CONCLUSIONSOne‐ and 3‐monthly formulations of leuprolide and goserelin have equivalent and sufficient effects to suppress serum testosterone levels in men with prostate cancer. There were testosterone levels just outside the castrate range in a few patients during treatment.

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Section: Discussionmentioning

confidence: 99%

Equivalent and sufficient effects of leuprolide acetate and goserelin acetate to suppress serum testosterone levels in patients with prostate cancer

et al. 2008

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“…Other situations related to the lack of efficacy of analogues could be the concurrent existence of hypophyseal adenomas [77], changes in analogue receptors, presence of antibodies against them, and fast metabolization or absorption disorders [43,78].…”

Section: Indirect Evidence Obtained From Rctsmentioning

confidence: 99%

Evidence‐based medicine: comparative analysis of luteinizing hormone‐releasing hormone analogues in combination with external beam radiation and surgery in the treatment of carcinoma of the prostate

Gónzalez

Pijuan²

2010

BJU International

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What’s known on the subject? and What does the study add? Luteinizing hormone‐releasing hormone analogues are a cornerstone in the management of many clinical situations in prostate cancer patients. The multiplicity of drugs make it difficult to decide which is the best drug to prescribe to each patient. Whether or not the different luteinizing hormone‐releasing hormone analogues belong to the same drug class is only merely supposed. This study adds a systematic review of the literature in order to determine whether or not the luteinizing hormone‐releasing hormone analogues available for prescription belong to the same drug class (same family, similar chemical structure, mechanism of action, and efficacy). The current evidence available is not enough to support a presumed drug class effect of the various analogues in the treatment of prostate carcinoma. OBJECTIVE • To study whether luteinizing hormone‐releasing hormone (LHRH) analogues are agents of the same pharmacological class, i.e. whether they have the same clinical effect, using an evidence‐based medicine approach. MATERIAL AND METHODS • We reviewed the evidence on the alleged ‘drug class effect’ among analogues and the existing bibliographic support for their use in various medical indications. We used PubMed as the main search source. Evidence level and degree of recommendation were assigned to each conclusion based on the ‘Scottish Intercollegiate Guidelines Network’. RESULTS • There are no studies designed to answer the question of class effect between LHRH analogues or agonists. Reviews and meta‐analyses have been performed on many other issues related to therapeutic management either with analogues alone, or in combination with radiation therapy and surgery. • Direct comparisons do not allow definitive conclusions to be reached. Indirect evidence is obtained from randomized studies comparing the different LHRH analogues with other treatments used to obtain androgen deprivation. Other issues related to pharmacokinetics and pharmacodynamics that can support either the existence or non‐existence of class effect were evaluated. CONCLUSION • The current available evidence is not enough to support a presumed class effect of the drug among the different analogues in the treatment of prostate carcinoma in its various clinical situations.

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“…Asimismo, los factores raciales podrían determinar la eficacia en cuanto a la castració n tras la DA, siendo mayor el efecto de los aná logos sobre los asiá ticos que sobre los caucasianos o los africanos 38 . Otras situaciones relacionadas con la ineficacia de los aná logos podrían deberse a la existencia de los adenomas pituitarios, las alteraciones en sus Rc, la existencia de anticuerpos contra estos, la rá pida metabolizació n o las alteraciones en la absorció n 60,61 .…”

Section: Evidencias Indirectas Obtenidas De Los Ensayos Clínicos Aleaunclassified

¿Se ha de asumir el efecto de clase farmacológica entre los diferentes análogos de la hormona liberadora de la hormona luteinizante usados en el tratamiento del carcinoma de próstata?

Vilar-González

Maldonado-Pijuan

Andrés-García

2010

Actas Urológicas Españolas

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Failure of a gonadotropin-releasing hormone analogue to lower serum testosterone in patients with prostate cancer

Cited by 6 publications

References 5 publications

Equivalent and sufficient effects of leuprolide acetate and goserelin acetate to suppress serum testosterone levels in patients with prostate cancer

Equivalent and sufficient effects of leuprolide acetate and goserelin acetate to suppress serum testosterone levels in patients with prostate cancer

Evidence‐based medicine: comparative analysis of luteinizing hormone‐releasing hormone analogues in combination with external beam radiation and surgery in the treatment of carcinoma of the prostate

¿Se ha de asumir el efecto de clase farmacológica entre los diferentes análogos de la hormona liberadora de la hormona luteinizante usados en el tratamiento del carcinoma de próstata?

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