Switching from an LHRH Antagonist to an LHRH Agonist: A Case Report of 10 Finnish Patients with Advanced Prostate Cancer

Abstract

IntroductionLuteinizing hormone-releasing hormone (LHRH) analogues are widely used for the treatment of advanced hormone-dependent prostate cancer. However, there are currently no clinical guidelines for switching between LHRH analogues. It has been reported that there may be clinical benefits for patients switching between different formulations of LHRH agonists, as well as from an LHRH agonist to LHRH antagonist, but there are no published data on switching from an LHRH antagonist to an LHRH agonist. In this paper, we summarize the clinical notes of 10 patients with hormone-sensitive advanced prostate cancer who switched from an LHRH antagonist to an LHRH agonist.MethodsPatients with T3N0M0–T4N1M1 prostate cancer experiencing injection site reactions, such as pain and swelling, with monthly degarelix (Firmagon®) subcutaneous injections were switched to the 3-monthly leuprorelin acetate implant (Leuprorelin Sandoz®) subcutaneous injections.ResultsMean patient age was 75 years (SD 8.3; range 59–85) and Gleason scores ranged from 7 to 9. The mean [±standard deviation (SD)] duration of degarelix treatment was 5 ± 3.7 months (range 2–13). After switching, prostate serum antigen levels were comparable or reduced from those measured prior to switching, showing that efficacy was not compromised. Throughout the course of treatment, no patients reported injection site reactions. Patients reported increased satisfaction with the leuprorelin acetate implant versus degarelix, mainly because of a lack of injection site reactions and reduced frequency of injection.ConclusionThis is the first report of the clinical experience and potential cost implications of switching from an LHRH antagonist to an LHRH agonist. These data are consistent with other experiences of switching between LHRH analogues in terms of efficacy, safety, and potential cost savings, and provide preliminary evidence that the switch from an LHRH antagonist to an agonist is safe and equally efficacious.

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

“…All patients who switched to the leuprorelin acetate implant in the adjuvant setting stated that they preferred to continue with this therapy. 41 Although further data are needed to support these preliminary findings in Croatia and Finland, they are in line with the EAU 2016 guidelines statement that LHRH agonists demonstrate similar efficacy but that variations in practical aspects need to be considered in everyday practice. 1…”

“…PSA levels measured before and after switching from an LHRH antagonist to an LHRH agonist: a Finnish case series. 41 LHRH, luteinizing hormone-releasing hormone; PSA, prostate-specific antigen. Reproduced under the Creative Commons Attribution-noncommercial 4.0 license (http://creativecommons.org/licenses/bync/4.0/) with permission, from Visapää H. Switching from a luteinising hormone-releasing hormone (LHRH) antagonist to a LHRH agonist: a report of 10 Finnish patients with advanced prostate cancer.…”

“…Although there have been many reports of switching from LHRH agonist to LHRH antagonist therapy, to our knowledge there is only one study evaluating switching from LHRH antagonist to LHRH agonist. 41 A total of 10 Finnish patients with advanced prostate cancer were switched from the monthly degarelix SC injection (Firmagon ® ; Ferring Pharmaceuticals), as they were experiencing injection site reactions, to the 3-monthly leuprorelin acetate implant. Post-switching mean PSA levels were similar or reduced compared with those measured prior to switching, indicating that there was no compromise in efficacy (Figure 2).…”

“…40 Similarly, in a small case series, Finnish patients with advanced prostate cancer receiving LHRH agonist therapy were reported to prefer 3-monthly versus 1-monthly injections. 41 Regular contact with healthcare professionals helps patients to cope with the effects of their disease and its management on quality of life. 40 Patients also appreciate regular monitoring of their PSA and testosterone levels to ascertain if their treatment is working.…”

A Case of Switching from GnRH Agonist to Antagonist for Castration Resistant Prostate Cancer Control

“…For patients whose PSA levels are more than 20 ng/mL, GnRH antagonist treatment prolonged overall survival in comparison to GnRH agonist treatment [3]. Harri et al reported a case series in which GnRH agonists and antagonists were switched in Finnish prostate cancer patients [8]. The detailed mechanisms are still unknown; however, one possibility is that GnRH antagonists also lower the serum FSH level and that this decrease in FSH might be associated with an anti-tumor effect in prostate cancer.…”