Comparing the Impact of ADT Agents on Cardiovascular Events and Death in Men with Prostate Cancer

Rosemary Frei, MSc

July 2013, Vol 4, No 6 - Prostate Cancer

Niagara Falls, Ontario—Among men with prostate cancer and preexisting cardiovascular (CV) disease, the risk of CV events or CV-related death is cut in half when they receive androgen-deprivation therapy (ADT) with degarelix (Firmagon) instead of the luetinizing hormone–releasing hormone (LHRH) agonists goserelin (Zoladex) or leuprolide (Lupron), according to results of a new analysis presented at the 2013 Canadian Urological Association annual meeting.

An examination of pooled data from 6 prospective, randomized trials showed that the probability of CV events or death is reduced by 51.2% with degarelix versus one of the 2 LHRH agonists.

Lead investigator Laurence Klotz, MD, Chief, Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, said that the results triumphed over his initial skepticism that simply having a different mode of action (degarelix is a gonadotropin- releasing hormone antagonist) would alter the chance of CV events.

“Degarelix is not just a way to lower testosterone, but it has some real advantage over LHRH agonists besides reducing flares,” Dr Klotz concluded after presenting the results of the analysis.

His team focused on CV events and death data from three 3-month and three 12-month randomized controlled trials of ADT agents. A total of 1491 patients in the trials received degarelix, 458 received goserelin, and 379 took leuprolide.

The patients receiving degarelix and LHRH agonists had similar baseline characteristics, including average age (71.7 years vs 71.6 years, respectively)and rates of smokers (59% vs 52%, respectively).

Overall, 53 (3.6%) of the patients who received degarelix and 48 (5.7%) of those who received an LHRH agonist had a CV event or died from any cause during the trials. This translated into a significantly reduced risk of a CV event or death over 1 year of treatment with degarelix.

Men with a history of CV disease who received degarelix had a significant reduction in events or death versus those who received LHRH agonists, whereas those without a history of CV disease did not experience this reduction. Men receiving degarelix, with or without a history of CV disease, also had a significantly increased probability of overall survival.

A multivariable analysis revealed an estimated hazard ratio of 0.488 for CV events or death in men with a history of CV disease who received degarelix versus men who received an LHRH agonist. Alcohol consumption and having a low serum testosterone level were also protective against having a CV event and against death.