Long-Term Therapy with a Depot Luteinizing Hormone-Releasing Hormone Analogue (Zoladex) in Patients with Advanced Prostatic Carcinoma

Abstract

We treated 191 patients with histologically proved locally advanced stage (T3 or T4) and/or metastatic prostate cancer with a biodegradable depot formulation of a luteinizing hormone-releasing hormone analogue (Zoladex). After an initial increase in serum testosterone in week 1 of therapy a continuous decrease of testosterone to castrate levels was obtained. With a monthly injection of the luteinizing hormone-releasing hormone analogue 4 patients (2 per cent) experienced a transient increase in bone pain, 1 had ureteral obstruction and 1 suffered paraplegia during the first few weeks of therapy. Over-all objective and subjective responses were similar to those obtained by castration or estrogen therapy. The absence of local and systemic (long-term) side effects proves the validity of this approach for patients with advanced prostatic cancer.

Long-Term Efficacy and Safety of Nilutamide Plus Castration in Advanced Prostate Cancer, and the Significance of Early Prostate Specific Antigen Normalization

“…In contrast, other generally smaller studies have indicated no improvements in survival or interval to disease progression for maximal an drogen blockade compared to castration.2>10 ' 15-18 In our study orchiectomy was chosen rather than luteiniz ing hormone-releasing hormone agonists not only to avoid any compliance problems relating to the method of castration but also to avoid disease flare found in up to 5% of patients receiving luteinizing hormone-releasing hormone agonists as monotherapy. 19 This choice also allows the long-term efficacy of the antiandrogen to be related to its self-effect rather than to the prevention of disease flare.…”

A New Longer-Acting LHRH Analog Depot: Preliminary Results of a Dutch Open Phase II Clinical Study on a 10.8 mg Zoladex 3-Monthly Depot

“…It is also most unlikely that any increase in bone pain is a sign of a new osteoblastic lesion; it probably reflects a minor and temporary stim ulation of a pre-existing lesion. Although Debruyne [12] did describe 1 patient with acute paralysis of the legs fol lowing such treatment this was also probably the result of terminal erosion of a pre-existing spinal deposit. In our study, only 1 patient needed bladder catheteriza tion, though in the study of Parmar, using a different analog, there were more urinary symptoms [5], Hot flashes, breast tenderness, loss of libido and impotence can be considered as physiologic hormonal side-effects.…”

Casodex™ (Bicalutamide): Overview of a New Antiandrogen Developed for the Treatment of Prostate Cancer

“…However, with LHRH analogue monotherapy, the incidence of tumour flare is generally higher (5%) [43], During combination therapy, the incidence of hepatic events was lower in Casodex-LHRH analogue treated patients than in flutamide-LHRH analogue treated pa tients (6.2% versus 10.3%, respectively). By comparison, the incidence of hepatic adverse events in the entire monotherapy programme of studies was 1.5% in Casodex-treated patients compared with 1.1% in castrated pa tients.…”