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Year : 2022  |  Volume : 59  |  Issue : 5  |  Page : 142-159

Gonadotropin-releasing hormone agonists in prostate cancer: A comparative review of efficacy and safety

1 Department of Medical Oncology, Apollo Hospital, Chennai, Tamil Nadu, India
2 Department of Medical Oncology, Command Hospital Airforce, Bangalore, Karnataka, India
3 Department of Uro Oncology, Apollo Hospital, Hyderabad, Telangana, India
4 Department of Uro-oncology, RKM Seva Pratishthan, Kolkata, West Bengal, India
5 Department of Radiation Oncology, HCG Hospital, Bangalore, Karnataka, India
6 Medical Oncology and Hematology, Safdarjung Hospital & VMMC, New Delhi, India
7 Medical Oncologist, Hospital Ruby Hall Clinic, New Cancer Building, Pune, Maharashtra, India
8 Medical Affairs, AstraZeneca Pharma India Ltd, Manyatha Tech Park, Rachenahalli, Bangalore, Karnataka, India, Bangalore

Correspondence Address:
Ketaki Patil
Medical Affairs, AstraZeneca Pharma India Ltd, Manyatha Tech Park, Rachenahalli, Bangalore, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijc.IJC_65_21

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Androgen deprivation therapy (ADT) using gonadotropin-releasing hormone agonist (s) (GnRH-A) remains the backbone of advanced prostate cancer treatment. In this review, we assessed the efficacy, safety, and convenience of administration of various GnRH-A. All GnRH-A (goserelin, triptorelin, buserelin, histrelin, and leuprorelin) have comparable potential to suppress testosterone (T) levels (≤50 ng/dL in a month and ≤20 ng/dL in 3 months). However, goserelin has shown better efficacy in maintaining T levels ≤50 ng/dL compared with leuprolide. The incidences of T escape are lower with goserelin and leuprolide than buserelin. Goserelin also has maximum benefit in prostate-specific antigen suppression. In neoadjuvant setting, when only goserelin was used, the 10-year overall survival (OS) rate was 42.6% to 86%. When either goserelin or leuprolide was used, the 10-year OS rate was 62%. As an adjuvant to radical prostatectomy, goserelin had a 10-year survival rate of 87%, and triptorelin had an 8-year survival rate of 84.6%. Goserelin further showed an absolute survival rate of 49% when used as an adjuvant to radiotherapy. The survival rates further improved when GnRH-A are used as combined androgen blockade compared with monotherapy. The frequency and severity of adverse events (hot flushes, fatigue, sexual dysfunction) are comparable among the GnRH-A. Goserelin appears to be the most convenient of all the GnRH-A for administration. Lack of conclusive comparative evidence makes it imperative to have a holistic approach of considering the patient profile and the disease characteristics to select the appropriate GnRH-A for ADT in prostate cancer.


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