The newest gonadotropin-releasing hormone (GnRH) antagonist therapy drug, degarelix (aka Firmagon) has become more commonly used in everyday clinical practice as an alternative hormone therapy treatment drug (ADT). Given that its use has become common it is important to understand both its safety and efficacy as compared to our older standard drugs.

The best way to track this type of information is through a registry. This was done when researchers, using the registry data from uro-oncology practices in Germany, retrospectively analyzed the information contained in the IQUO (Association for uro-oncological quality assurance) patient registry. They evaluated data prospectively collected from consecutive prostate cancer patients treated with degarelix (n?=?1010) in 138 uro-oncology practices in Germany between May 2009 and December 2013.

Their analysis found that the median overall survival had not yet been reached in the all-patient groups or in the subgroups who had or had not received prior hormonal therapy (ADT). However, they did find that in the men who had received prior ADT (n?=?542) had a 58 % increased mortality risk versus men who had not (n?=?468).

They also found that in the men who had received prior luteinizing hormone-releasing hormone (LHRH) analogue therapy (LHRH agonists or GnRH antagonists), the median time to PSA progression was shorter (209 weeks) than in those who had not received prior LHRH analogues (n?=?555; median PSA progression-free survival not yet reached).

The Take Home

Degarelix was very effective and well tolerated in everyday clinical practice. Men who received prior ADT appeared to have a significantly higher mortality risk. This could be do to the drugs themselves or possibly because men who have already been on ADT have had more time to progress and develop additional mutations. What we need is a trial looking at survival numbers of men using either Degarelix or some of the older drugs at diagnosis so that we compare apples to apples.

BMC urology. 2015 Dec 16*** epublish ***

Götz Geiges, Thomas Harms, Gerald Rodemer, Ralf Eckert, Frank König, Rolf Eichenauer, Jörg Schroder