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| REVIEW ARTICLE |
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| Year : 2022 | Volume
: 59
| Issue : 5 | Page : 160-174 |
A review of clinical evidence to assess differences in efficacy and safety of luteinizing hormone–releasing hormone (LHRH) agonist (goserelin) and LHRH antagonist (degarelix)
Ankur Bahl1, Senthil Rajappa2, Sudhir Rawal3, Ganesh Bakshi4, Vedang Murthy5, Ketaki Patil6
1 Senior Consultant, Medical Oncology and Hematology, Max Cancer Centre, New Delhi, India
2 Consultant Medical Oncologist, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, India
3 Medical Director, Chief Genito Uro-Oncology, RCGI, Delhi, India
4 Department of Uro oncology, P D Hinduja National Hospital, Mahim, Mumbai, India
5 Professor & Radiation Oncologist, Tata Memorial Center, Mumbai, India
6 Medical Affairs, AstraZeneca Pharma India Ltd, Manyatha Tech Park, Rachenahalli, Bangalore, India
Correspondence Address:
Ketaki Patil
Medical Affairs, AstraZeneca Pharma India Ltd, Manyatha Tech Park, Rachenahalli, Bangalore
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijc.IJC_1415_20
Luteinizing hormone–releasing hormone agonist (LHRH-A), goserelin, and antagonist, degarelix, are both indicated for the treatment of advanced prostate cancer (PCa); however, large comparative trials evaluating their efficacy and safety are lacking. In this review, we assessed the available evidence for both the drugs. Although degarelix achieves an early rapid decline in testosterone (T) and prostate-specific antigen (PSA) levels, median T and PSA levels, in addition to prostate volume and International Prostate Symptom Scores, become comparable with goserelin over the remaining treatment period. Degarelix causes no initial flare, therefore it is recommended in patients with spinal metastases or ureteric obstruction. Goserelin achieves lower PSA, improved time to progression, and better survival outcomes when administered adjunctively to radiotherapy compared with radiotherapy alone, with significant results even over long-term follow-up. The evidence supporting adjuvant degarelix use is limited. Goserelin has better injection site safety, single-step delivery, and an efficient administration schedule compared with degarelix, which has significantly higher injection site reactions and less efficient administration mechanism. There is conflicting evidence about the risk of cardiovascular disease (CVD), and caution is required when using LHRH-A in patients with preexisting CVD. There is considerable long-term evidence for goserelin in patients with advanced PCa, with degarelix being a more recent option. The available comparative evidence of goserelin versus degarelix has several inherent limitations related to study design, sample size, conduct, and statistical analyses, and hence warrants robust prospective trials and long-term follow-up.
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