The oral antagonist relugolix allows for rapid testosterone recovery after discontinuation. While useful for planned intermittent therapy, a case study shows this can be a clinical pitfall. In non-adherent patients who self-discontinue, it can lead to an equally rapid rise in PSA and disease progression.
The HERO trial found the GnRH antagonist relugolix reduced major adverse cardiovascular events (MACE) by 54% compared to the agonist leuprolide. While absolute rates were low (2.8% vs 5.6%), this suggests a significant safety advantage for antagonists in patients with cardiovascular risk.
Contrary to concerns about compliance with daily oral medication, real-world retrospective studies show patients demonstrate higher persistence and adherence to oral relugolix compared to traditional injectable GnRH agonists and antagonists for prostate cancer, challenging clinical biases.
A real-world case study shows how payer restrictions, not clinical judgment, can dictate cancer treatment. A patient was forced to switch from a well-tolerated drug (darolutamide) to another (apalutamide), which caused a rash, before the original, more suitable therapy could be re-justified and approved.
Androgen deprivation therapy induces metabolic syndrome-like effects, increasing cardiovascular risk. It is the medical oncologist's responsibility to perform a baseline CV risk assessment using tools like the STAMP questions and to engage cardiology partners when needed for risk mitigation.
Transdermal estradiol is gaining renewed attention as an ADT option. Recent trials show it is non-inferior to standard LHRH analogs, offering a different side effect profile. This allows clinicians to trade side effects like hot flashes for gynecomastia, enabling more personalized treatment decisions.