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© The Canadian Journal of Urology™; 18(Supplement 1); April 2011
TABLE 8a.
LHRH agonist and LHRH antagonists as hormonal therapy for prostate cancer
Name (Brand)
Class
Administration
Notes
Buserelin
(Suprefact [Canada only]) LHRH
SC: 500 mcg q8h X 7 days
Can cause initial
agonist
then 200 mcg daily;
hormonal surge
Depot 2-month:
6.3 mg implant every 8 weeks
Depot 3-month:
9.45 mg implant every 12 weeks
Intranasal: 400 mcg
(200 mcg into each nostril)
3 times/day
Degarelix
LHRH
240 mg SC in 2 divided doses initially, No hormonal surge;
(Firmagon)
antagonist
the 80 mg SC every 28 days
administer in
abdominal wall
Goserelin acetate
LHRH agonist 3.6 mg SC monthly (28 days);
Can cause initial
(Zoladex,
10.8 mg SC every 3 months (13 weeks) hormonal surge;
Zoladex LA)
SC resorbable
implant
Histrelin (Vantas)
LHRH agonist SC implant 50 mg every 12 months
Remove implant at
reinsertion; local
anesthesia, place in
upper inner arm
Leuprolide
LHRH agonist 7.5 mg IM monthly
Can cause initial
(Lupron Depot)
22.5 mg IM every 3 months;
hormonal surge
30 mg IM every (16 weeks)
Leuprolide gel
LHRH agonist 7.5 mg monthly;
Can cause initial
(Eligard)
22.5 mg every 3 months;
hormonal surge;
30 mg every 4 months;
requires refrigerated
45 mg every 6 months
storage
Leuprolide implant
LHRH agonist SC implant every 12 months
Off US market for new
(Viadur
(contains 65 mg leuprolide)
patients since 2008
[US, not Canada])
Triptorelin
LHRH agonist 3.75 mg IM monthly
Can cause initial
(Trelstar,
11.25 mg IM every 3 months
hormonal surge
Trelstar LA)
22.5 mg IM every 6 months (US only)
skeletal events in men with metastatic prostate cancer,
Table 8b.
70
More recently in 2010, denosumab [Xgeva
(US only)], a human monoclonal antibody against
the receptor activated of nuclear factor k-B ligand
(RANKL) was studied in a randomized phase III
trial versus zoledronic acid to treat men with bone
metastases from castrate-resistant prostate cancer,
Table 8b.
71,72
Denosumab demonstrated a delay to the
primary endpoint (defined as time to first on-study
skeletal-related event – occurrence of a pathologic
fracture, bone radiation or surgery, or spinal cord
compression) by 18% with a difference of 3.6 months.
Physicians should be aware of skeletal related events
in their patients with metastatic prostate cancer and
34
LIU ET AL.