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Chen N, Wang Z, Chen M, Ma Q, He Y, Wang Y, Li X, Qiu M, Shi L, Zhu S, Xie Q, Liu X, Shi B, Lin G, Yang W, Liao Y, Zhang H, Wang S, Li J, Wang S, Dong L, Chen H, Lu J, Cheng Y, Zhang X, Ma L, Zhou L, Wang H, Li S, Ye D. Real-world effectiveness and safety of goserelin 10.8-mg depot in Chinese patients with localized or locally advanced prostate cancer. Cancer Biol Med 2024; 20:j.issn.2095-3941.2023.0335. [PMID: 38318809 PMCID: PMC10845927 DOI: 10.20892/j.issn.2095-3941.2023.0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/04/2023] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE Real-word data on long-acting luteinizing hormone-releasing hormone (LHRH) agonists in Chinese patients with prostate cancer are limited. This study aimed to determine the real-world effectiveness and safety of the LHRH agonist, goserelin, particularly the long-acting 10.8-mg depot formulation, and the follow-up patterns among Chinese prostate cancer patients. METHODS This was a multicenter, prospective, observational study in hormone treatment-naïve patients with localized or locally advanced prostate cancer who were prescribed goserelin 10.8-mg depot every 12 weeks or 3.6-mg depot every 4 weeks with or without an anti-androgen. The patients had follow-up evaluations for 26 weeks. The primary outcome was the effectiveness of goserelin in reducing serum testosterone and prostate-specific antigen (PSA) levels. The secondary outcomes included testosterone and PSA levels, attainment of chemical castration (serum testosterone <50 ng/dL), and goserelin safety. The exploratory outcome was the monitoring pattern for serum testosterone and PSA. All analyses were descriptive. RESULTS Between September 2017 and December 2019, a total of 294 eligible patients received ≥ 1 dose of goserelin; 287 patients (97.6%) were treated with goserelin 10.8-mg depot. At week 24 ± 2, the changes from baseline [standard deviation (95% confidence interval)] in serum testosterone (n = 99) and PSA (n = 131) were -401.0 ng/dL [308.4 ng/dL (-462.5, -339.5 ng/dL)] and -35.4 ng/mL [104.4 ng/mL (-53.5, -17.4 ng/mL)], respectively. Of 112 evaluable patients, 100 (90.2%) achieved a serum testosterone level < 50 ng/dL. Treatment-emergent adverse events (TEAEs) and severe TEAEs occurred in 37.1% and 10.2% of patients, respectively. The mean testing frequency (standard deviation) was 1.6 (1.5) for testosterone and 2.2 (1.6) for PSA. CONCLUSIONS Goserelin 10.8-mg depot effectively achieved and maintained castration and was well-tolerated in Chinese patients with localized and locally advanced prostate cancer.
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Affiliation(s)
- Nanhui Chen
- Department of Urology, Meizhou People’s Hospital, Meizhou 514089, China
| | - Zengjun Wang
- Department of Urology, Jiangsu Province Hospital, Nanjing 210029, China
| | - Ming Chen
- Department of Urology, Zhongda Hospital Southeast University, Nanjing 210009, China
| | - Qi Ma
- Translational Research Laboratory for Urology, Ningbo First Hospital, Ningbo 315016, China
| | - Yi He
- Department of Urology, First Affiliated Hospital of Jiaxing, Jiaxing 314050, China
| | - Yujie Wang
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830091, China
| | - Xin Li
- Department of Urology, Baotou Cancer Hospital, Baotou 014016, China
| | - Mingxing Qiu
- Department of Urology, The People’s Hospital of Sichuan Province, Chengdu 610032, China
| | - Lei Shi
- Department of Urology, Yantai Yuhuangding Hospital, Yantai 264008, China
| | - Shaoxing Zhu
- Department of Urology, Cancer Hospital of The University of Chinese Academy of Sciences, Hangzhou 310022, China
| | - Qun Xie
- Department of Urology, Zhuhai Hospital Affiliated with Jinan University, Zhuhai 519000, China
| | - Xiuheng Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, HUST, Wuhan 430032, China
| | - Benkang Shi
- Department of Urology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Guowen Lin
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Weizhong Yang
- Department of Urology, Huizhou Third People’s Hospital, Huizhou 516002, China
| | - Yongbin Liao
- Department of Urology, Jiangmen Central Hospital, Jiangmen 529030, China
| | - Haibin Zhang
- Department of Urology, Foshan First People’s Hospital, Foshan 528041, China
| | - Shusheng Wang
- Department of Urology, Guangzhou Province Traditional Chinese Medical Hospital, Guangzhou 510120, China
| | - Jiexian Li
- Department of Urology, Guangzhou Panyu Central Hospital, Guangzhou 511489, China
| | - Shaogang Wang
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430064, China
| | - Lijun Dong
- Department of Urology, Hebei Petro China Central Hospital (China National Petroleum Corporation Central Hospital), Langfang 065099, China
| | - Hui Chen
- Department of Urology, Harbin Medical University Cancer Hospital, Harbin 150086, China
| | - Jiaju Lu
- Department of Urology, Shandong Provincial Hospital, Jinan 250014, China
| | - Yongyi Cheng
- Department of Urology, Shaanxi Provincial People’s Hospital, Xi’an 710021, China
| | - Xiaoping Zhang
- Department of Urology, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan 430032, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - He Wang
- Department of Urology, Tangdu Hospital, Xi’an 710024, China
| | - Shen Li
- Department of Urology, Shijiazhuang City First Hospital, Shijiazhuang 050012, China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
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Kim SE, Kim WJ, Choi D, Lee DY. Comparison of goserelin and leuprorelin for ovarian protection during chemotherapy in young patients with breast cancer. Breast Cancer Res Treat 2023; 198:231-237. [PMID: 36781519 DOI: 10.1007/s10549-023-06877-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/01/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Although different gonadotropin-releasing hormone (GnRH) agonists may have different effects, their effect of ovarian protection during chemotherapy for breast cancer has not been compared. This study aimed to compare the effects of goserelin and leuprorelin for ovarian protection during chemotherapy in young patients with breast cancer. METHODS This prospective study analyzed 193 patients with breast cancer aged ≤ 40 years who had regular menstruation and serum anti-Müllerian hormone (AMH) levels ≥ 1 ng/mL before treatment. Patients received either goserelin or leuprorelin for ovarian protection during doxorubicin/cyclophosphamide-based chemotherapy. Resumption of menstruation and changes in serum levels of AMH were compared between the two groups at 12 months after completion of chemotherapy. RESULTS The mean age and the pretreatment serum AMH level were 33.2 years and 4.4 ng/mL in goserelin group and 34.2 years and 4.0 ng/mL in leuprorelin group. The proportion of patients who resumed menstruation was not different between the goserelin (94.4%) and leuprorelin (95.3%) groups at 12 months after chemotherapy completion. Serum AMH levels decreased significantly in both the goserelin (from 4.4 to 1.2 ng/mL) and leuprorelin (from 4.0 to 1.2 ng/mL) groups, with no statistical significance. In addition, no difference was found in the proportion of patients with serum AMH levels ≥ 1 ng/mL between the goserelin (49.5%) and leuprorelin (44.2%) groups at 12 months after chemotherapy. CONCLUSION Goserelin and leuprorelin were comparable in terms of ovarian protection during doxorubicin/cyclophosphamide-based chemotherapy in young patients with breast cancer.
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Affiliation(s)
- Sung Eun Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Won-Ji Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - DooSeok Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
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Mangesius J, Minasch D, Fink K, Nevinny-Stickel M, Lukas P, Ganswindt U, Seppi T. Systematic risk analysis of radiation pneumonitis in breast cancer: role of cotreatment with chemo-, endocrine, and targeted therapy. Strahlenther Onkol 2023; 199:67-77. [PMID: 36515701 PMCID: PMC9839789 DOI: 10.1007/s00066-022-02032-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/20/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE A major complication of sequential and concomitant chemoradiation in breast cancer treatment is interstitial pneumonitis induced by radiation therapy (RT), systemic therapy, or a combination of both. Dose and volume of co-irradiated lung tissue directly correlate with the risk of radiation pneumonitis. Especially in case of combined treatment, it is often unclear which of the used therapeutic agents promote pneumonitis. METHODS This was a prospective monocentric study including 396 breast cancer patients. A systematic analysis of single and combined therapeutic measures was performed in order to identify treatment-related factors enhancing the risk of pneumonitis post RT. RESULTS Overall incidence of pneumonitis of any grade was 38%; 28% were asymptomatic (grade 1) and 10% were symptomatic (> grade 1). Pneumonitis > grade 2 did not occur. Beside age, smoking status, and mean lung dose, the combined treatment with goserelin and tamoxifen significantly enhanced the risk of pneumonitis in a supra-additive pattern (odds ratio [OR] 4.38), whereas each agent alone or combined with other drugs only nonsignificantly contributed to a higher pneumonitis incidence post RT (OR 1.52 and OR 1.16, respectively). None of the other systemic treatments, including taxanes, increased radiation pneumonitis risk in sequential chemoradiation. CONCLUSION Common treatment schedules in sequential chemoradiation following breast-conserving surgery only moderately increase lung toxicity, mainly as an asymptomatic complication, or to a minor extent, as transient pneumonitis ≤ grade 2. However, combined treatment with tamoxifen and the LHRH analog goserelin significantly increased the risk of pneumonitis in breast cancer patients after chemoradiation. Thus, closer surveillance of involved patients is advisable.
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Affiliation(s)
- Julian Mangesius
- grid.5361.10000 0000 8853 2677Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Anichstr. 35, Austria
| | - Danijela Minasch
- grid.5361.10000 0000 8853 2677Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Anichstr. 35, Austria
| | - Katharina Fink
- grid.5361.10000 0000 8853 2677Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Anichstr. 35, Austria
| | - Meinhard Nevinny-Stickel
- grid.5361.10000 0000 8853 2677Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Anichstr. 35, Austria
| | - Peter Lukas
- grid.5361.10000 0000 8853 2677Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Anichstr. 35, Austria
| | - Ute Ganswindt
- grid.5361.10000 0000 8853 2677Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Anichstr. 35, Austria
| | - Thomas Seppi
- grid.5361.10000 0000 8853 2677Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Anichstr. 35, Austria
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Wang S, Pei L, Hu T, Jia M, Wang S. Protective effect of goserelin on ovarian reserve during (neo)adjuvant chemotherapy in young breast cancer patients: a prospective cohort study in China. Hum Reprod 2021; 36:976-986. [PMID: 33411897 DOI: 10.1093/humrep/deaa349] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/15/2020] [Indexed: 12/15/2022] Open
Abstract
STUDY QUESTION Does goserelin, a GnRH agonist, have a protective effect in young breast cancer patients in terms of ovarian reserve markers anti-Müllerian hormone (AMH) and antral follicle count (AFC) during chemotherapy? SUMMARY ANSWER Compared with chemotherapy alone, concurrent goserelin is associated with a higher probability of ovarian reserve recovery at 1 year after chemotherapy. WHAT IS KNOWN ALREADY Previous studies on the administration of goserelin to protect ovarian function during chemotherapy have produced conflicting results because of the endpoint used, namely, chemotherapy-induced amenorrhoea. Reproductive medicine specialists consider AMH and AFC as the most sensitive ovarian reserve markers; however, they have never been used as biomarkers to assess the potential protective effects on ovarian reserve of goserelin during chemotherapy. STUDY DESIGN, SIZE, DURATION This was a prospective cohort study in which patients were assigned to receive (neo)adjuvant chemotherapy with goserelin (the goserelin group) or without goserelin (the control group) according to each patient's preference. Of 242 breast cancer patients enrolled between December 2015 and November 2019, 76 in control group and 73 in goserelin group were able to be assessed at 1 year after chemotherapy. PARTICIPANTS/MATERIALS, SETTING, METHODS Premenopausal patients with a regular menstrual cycle and aged 18-45 years were eligible for enrolment if they were newly diagnosed with stages I-III breast cancer for which treatment with adjuvant or neoadjuvant chemotherapy was planned. Each patient in the goserelin group was given a subcutaneous dose of 3.6 mg at least 1 week before the first cycle of chemotherapy and then every 4 weeks for the duration of chemotherapy. Ovarian reserve markers and menstrual status were evaluated before and after chemotherapy in the two treatment groups. The primary endpoint was the AMH recovery rate, the secondary endpoints were the recovery rates of AFC, estradiol (E2), follicle-stimulating hormone (FSH) and menstruation. MAIN RESULTS AND THE ROLE OF CHANCE Among 149 patients (76 in the control group and 73 in the goserelin group) with complete data at 1 year after chemotherapy, the adjusted recovery rate of AMH was 46.5% and 21.8% in the goserelin group and control group, respectively (odds ratio: 3.08; P = 0.002). The trends in AFC and FSH recovery rates were consistent with that in AMH recovery rate. Notably, AMH levels remained low in 41.3% of patients whose menstrual activity had resumed. LIMITATIONS, REASONS FOR CAUTION Randomisation was not performed because of ethical considerations, so selection bias was inevitable, although propensity score weighting was done. The study was also underpowered because 21.5% (52/242) of enrolled patients received GnRH agonist-containing endocrine therapy and could not be analysed at 1 and 2 years after chemotherapy. WIDER IMPLICATIONS OF THE FINDINGS Our results indicate that co-administration of goserelin with chemotherapy provides obvious ovarian reserve protection in these young breast cancer patients. We expect that these results will be applicable in clinical practice for young breast cancer patients. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the National Key R&D Program of China No. 2016YFC0901302, by the Research and Development Fund of Peking University People's Hospital No. RD2014-13, RDY2017-19 and by AstraZeneca. The authors have no disclosures. TRIAL REGISTRATION NUMBER NCT02430103.
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Affiliation(s)
- Siyuan Wang
- Department of Breast Surgery, Peking University People's Hospital, Beijing, China
| | - Lin Pei
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Taobo Hu
- Department of Breast Surgery, Peking University People's Hospital, Beijing, China
| | - Mei Jia
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Shu Wang
- Department of Breast Surgery, Peking University People's Hospital, Beijing, China
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Aljabri B, Lilleby W, Switlyk MD, Tafjord G. Restart of androgen deprivation therapy after goserelin induced pituitary apoplexy in a patient with disseminated prostate cancer a case report and five-years follow-up. Urol Case Rep 2021; 37:101648. [PMID: 33868933 PMCID: PMC8044649 DOI: 10.1016/j.eucr.2021.101648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 11/16/2022] Open
Abstract
Pituitary apoplexy is a clinical syndrome caused by hemorrhage or infarction of a pituitary adenoma. There have been a few reports in the literature of rapid onset of pituitary apoplexy after goserelin injection. To the best of our knowledge, there is no publication in the literature reporting re-introducing goserelin therapy for patients with prostate cancer after the onset of pituitary apoplexy. In this case report, we present the onset and clinico-radiological course of pituitary apoplexy induced by the initiation of goserelin and during continuation of goserelin with up to five-years follow-up.
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Affiliation(s)
- Belal Aljabri
- Department of Oncology, The Norwegian Radiumhospitalet, Oslo University Hospital, Oslo, Norway.,Department of Palliative medicine, Akershus University Hospital, Lørenskog, Norway
| | - Wolfgang Lilleby
- Department of Oncology, The Norwegian Radiumhospitalet, Oslo University Hospital, Oslo, Norway
| | - Marta D Switlyk
- Department of Radiology, The Norwegian Radiumhospitalet, Oslo University Hospital, Oslo, Norway
| | - Gunnar Tafjord
- Department of Oncology, The Norwegian Radiumhospitalet, Oslo University Hospital, Oslo, Norway
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Zhao Y, Sun H, Zheng J, Shao C, Zhang D. Identification of predictors based on drug targets highlights accurate treatment of goserelin in breast and prostate cancer. Cell Biosci 2021; 11:5. [PMID: 33407865 PMCID: PMC7788753 DOI: 10.1186/s13578-020-00517-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/11/2020] [Indexed: 01/18/2023] Open
Abstract
Goserelin is an effective alternative to surgery or estrogen therapy in prostate cancer palliation, and possibly to ovariectomy in premenopausal breast cancer. However, not all users of goserelin can benefit from it, or some patients are not sensitive to goserelin. The advent of network pharmacology has highlighted the need for accurate treatment and predictive biomarkers. In this study, we successfully to identify 76 potential targets related to the compound of goserelin through network pharmacology approach. We also identified 18 DEGs in breast cancer tissues and 5 DEGs in cells, and 6 DEGs in prostate cancer tissues and 9 DEGs in cells. CRABP2 is the common DEG both in breast and prostate cancer. The risk prediction models constructed with potential prognostic targets of goserelin can successfully predict the prognosis in breast and prostate cancer, especially for very young breast cancer patients. Moreover, seven subgroups in breast cancer and six subgroups in prostate cancer were respectively identified based on consensus clustering using potential prognostic targets of goserelin that significantly influenced survival. The expression of representative genes including CORO1A and ANXA5 in breast and DPP4 in prostate showed strong correlations with clinic-pathological factors. Taken together, the novel signature can facilitate identification of new biomarkers which sensitive to goserelin, increase the using accuracy of goserelin and clarify the classification of disease molecular subtypes in breast and prostate cancer.
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Affiliation(s)
- Yue Zhao
- Department of Urology, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Huimin Sun
- Department of Urology, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Clinical Central Research Core, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jianzhong Zheng
- Department of Urology, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Chen Shao
- Department of Urology, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
| | - Dongwei Zhang
- Department of Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
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R L, A Y, J M, L F, V J. The affect of goserelin on the QoL of women having chemotherapy for EBC: Results from the OPTION trial. Breast 2020; 52:122-131. [PMID: 32505861 PMCID: PMC7303950 DOI: 10.1016/j.breast.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022] Open
Abstract
Background The OPTION trial results showed that premenopausal women with early stage breast cancer (EBC) receiving chemotherapy benefited from ovarian function protection with goserelin. The impact of treatments on patient reported Quality of Life (QoL) were also examined. Patients and methods 227 pre-menopausal women with EBC, were randomly assigned to chemotherapy±goserelin (C±G); 132 (58%) were ER-ve. Patients were stratified by age (≤40 years and >40 years). QoL was assessed with the Functional Assessment of Cancer Therapy – Breast, and Endocrine Symptom checklist at baseline (pre-treatment), 3, 6, 12, 18 and 24 months, then annually to 5 years. Treatment Outcome Index (TOI) score was the primary outcome. Results 213 patients were available for QoL analysis. There was a significant decrease in TOI scores for both treatment groups at 3 and 6 months that returned to pre-treatment levels at 12 months, then continued to increase reflecting improved QoL. By 3 months there was a significant difference from baseline in both groups for menopausal symptoms, and between groups in the proportion experiencing hot flushes at any time. The C + G group experienced higher levels of vasomotor symptoms generally during the treatment phase; by 24 months, the short-term negative effect of goserelin was reversed, with hot flushes twice as frequent in the chemotherapy only group (40.9% vs 21.3%). Conclusions These results show that young women diagnosed with breast cancer experienced only a short-term decrease in QoL from the addition of goserelin, in order to preserve ovarian function during chemotherapy treatment. Ovarian damage from breast cancer chemotherapy is a concern for the younger patient. OPTION showed goserelin reduced the rate of premature ovarian insufficiency in the ≤40yrs. Patient reported QoL is an important consideration in evaluating these treatments. OPTION QoL revealed greater vasomotor symptoms with goserelin at 3 and 6 mths. Overall goserelin treatment resulted in only a short term decrease in QoL.
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Affiliation(s)
- Leonard R
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Yellowlees A
- Quantics Consulting Ltd, Edinburgh, United Kingdom
| | - Mansi J
- Department of Oncology, Guy's and St Thomas' NHS Foundation Hospital, London, United Kingdom
| | - Fallowfield L
- Sussex Health Outcomes Research & Education in Cancer (SHORE -C) University of Sussex, United Kingdom
| | - Jenkins V
- Sussex Health Outcomes Research & Education in Cancer (SHORE -C) University of Sussex, United Kingdom.
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Mohammed NH, Al-Taie A, Albasry Z. Evaluation of goserelin effectiveness based on assessment of inflammatory cytokines and symptoms in uterine leiomyoma. Int J Clin Pharm 2020; 42:931-7. [PMID: 32350747 DOI: 10.1007/s11096-020-01030-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
Background Uterine leiomyoma is a benign tumour of the uterine smooth muscles associated with an elevated level of inflammatory cytokines. Goserelin, a synthetic gonadotropin-releasing hormone analogue, suppresses the production of sex hormones and release of inflammatory cytokines in uterine leiomyoma cells. Objective The primary objective of this study was to find out the effectiveness of subcutaneous goserelin therapy on lowering serum levels of inflammatory cytokines and improving uterine leiomyoma-related symptoms in female patients diagnosed with uterine leiomyoma. The secondary objective was to assess the tolerability to goserelin therapy used in the management of this tumour. Setting Outpatient gynaecological clinic of the medical consultation department of Baghdad Teaching Hospital, Baghdad province, Iraq. Methods A single centre, prospective, longitudinal, cohort study was carried out on female patients diagnosed with uterine leiomyoma. Goserelin 3.6 mg subcutaneous injection was given in a consecutive monthly dose for the total time duration of three months. Serum levels of inflammatory cytokines, tumour necrosis factor-α and monocyte chemotactic protein-1 were detected before and after goserelin therapy in a consecutive monthly assessment. The study also assessed the improvement in uterine leiomyoma-related symptoms, including pelvic pain alongside the incidence of goserelin-related side effects during therapy schedules. Main Outcome Measures Assessment of serum levels of tumour necrosis factor-α and monocyte chemotactic protein-1 alongside uterine leiomyoma-related symptoms, including pelvic pain and goserelin-related side effects. Results There was a significant decrease in serum levels of tumour necrosis factor-α and monocyte chemotactic protein-1 compared to the baseline level over the 3-month duration of goserelin therapy (0.11 ± 0.02 vs. 0.74 ± 0.19) pg/mL; (0.07 ± 0.00 vs. 0.44 ± 0.18) pg/mL respectively. Patients showed a clinical improvement regarding uterine leiomyoma-related symptoms following each of the consecutive monthly doses of goserelin therapy (n = 11, 55%, P < 0.0001; n = 15, 75%, P < 0.0001; n = 18, 90%, P < 0.0001) respectively. This also includes a significant decrease in the intensity of leiomyoma-related pelvic pain before and after goserelin therapy (7.2 ± 1.43 vs. 3.05 ± 1.14, P < 0.0001). The majority of patients reported vaginal dryness (60%) as the main goserelin-related side effect. Conclusion Goserelin therapy reduces serum levels of inflammatory cytokines, tumour necrosis factor- α and monocyte chemotactic protein-1, improving leiomyoma-related symptoms with good tolerability in patients with uterine leiomyoma.
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Takyi-Williams J, Erasmus L, Hayeshi R, Grobler A. Development and validation of an LC-MS/MS method for the quantification of goserelin in a Pheroid® formulation, in simulated intestinal fluid. J Pharm Biomed Anal 2020; 180:113044. [PMID: 31865209 DOI: 10.1016/j.jpba.2019.113044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 11/30/2022]
Abstract
The purpose of this reported study was to develop and validate an LC-MS/MS method for the quantification of goserelin in a Pheroid® formulation simulated intestinal fluid. Biopharmaceuticals are formulated in drug delivery systems to improve their gastrointestinal stability. Goserelin, a peptide drug was formulated in Pheroid® delivery system and its gastrointestinal stability assessed using simulated intestinal fluid, which required an assay to determine the varying amounts of goserelin remaining after a specific time. Several extraction methods and solvents investigated to extract goserelin from complex matrix led to either poor recovery, peak shape or high background interference. A rapid gradient reversed-phase method coupled to tandem mass spectrometry detection was optimized for the separation and quantification of the extracted peptide. A simple, reproducible and good recovery extraction procedure for goserelin quantification was achieved through simultaneous acetonitrile protein precipitation and water-saturated n-butanol liquid-liquid extraction with water dilution. The method was found to be rapid, specific, precise and accurate, and successfully applied to determine goserelin remaining content in a simulated intestinal fluid, with potential use in other lipid-based formulation evaluated in simulated intestinal fluids.
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Affiliation(s)
- John Takyi-Williams
- DST/NWU Preclinical Drug Development Platform (PCDDP), North-West University, South Africa.
| | - Linnè Erasmus
- DST/NWU Preclinical Drug Development Platform (PCDDP), North-West University, South Africa.
| | - Rose Hayeshi
- DST/NWU Preclinical Drug Development Platform (PCDDP), North-West University, South Africa.
| | - Anne Grobler
- DST/NWU Preclinical Drug Development Platform (PCDDP), North-West University, South Africa.
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Sun Y, Xie L, Xu T, Jakobsen JS, Han W, Sørensen PS, Wang X. Efficacy and safety of degarelix in patients with prostate cancer: Results from a phase III study in China. Asian J Urol 2019; 7:301-308. [PMID: 32742930 PMCID: PMC7385516 DOI: 10.1016/j.ajur.2019.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/24/2019] [Accepted: 07/08/2019] [Indexed: 01/25/2023] Open
Abstract
Objective To establish non-inferiority of gonadotropin-releasing hormone degarelix compared with goserelin in suppressing and maintaining castrate testosterone levels from Day 28 to Day 364 in Chinese patients with prostate cancer. Methods This is an open-label, multi-centre study in which men aged ≥18 years were randomised in a 1:1 ratio to once-a-month subcutaneous injection of either degarelix (240/80 mg) or goserelin (3.6 mg) for 12 months. The primary endpoint was difference in 1-year cumulative probability of suppressing testosterone to ≤0.5 ng/mL. Non-inferiority was to be established if the lower 95% confidence interval (CI) limit for difference in cumulative probability between the treatment arms was greater than −10%. Secondary endpoints included cumulative probability of prostate-specific-antigen-progression-free-survival (PSA-PFS). Safety was also assessed. Results Baseline demographics and disease characteristics were similar between degarelix (n=142) and goserelin (n=141) treatment arms. The difference in cumulative probability of maintaining castrate levels from Day 28–364 was 3.6% (95% CI:−1.5%, 8.7%), demonstrating non-inferiority of degarelix. The cumulative probability of PSA-PFS at Day 364 was higher for degarelix (82.3%, 95% CI: 74.7%, 87.7%) versus goserelin (71.7%, 95% CI: 63.2%, 78.5%, p=0.038). Adverse events (AEs) were similar between treatment arms, except for more injection site reactions with degarelix versus goserelin. Four (2.8%) and nine (6.4%) patients discontinued due to AEs in degarelix and goserelin groups, respectively. Conclusion Degarelix was non-inferior to goserelin in achieving and maintaining testosterone suppression at castrate levels during 1-year treatment. PSA-PFS was significantly higher with degarelix, suggesting improved disease control. Both treatments were well tolerated.
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Affiliation(s)
- Yinghao Sun
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Liping Xie
- Department of Urology, First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Tao Xu
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Jørn S Jakobsen
- Global Clinical Research and Development, Ferring Pharmaceuticals A/S, Copenhagen, Denmark
| | - Weiqing Han
- Department of Urology, Hunan Cancer Hospital, Hunan Province, China
| | - Per S Sørensen
- Global Clinical Research and Development, Ferring Pharmaceuticals A/S, Copenhagen, Denmark
| | - Xiaofeng Wang
- Department of Urology, Peking University People's Hospital, Beijing, China
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11
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Werutsky G, Maluf FC, Cronemberger EH, Carrera Souza V, dos Santos Martins SP, Peixoto F, Smaletz O, Schutz F, Herchenhorn D, Santos T, Mavignier Carcano F, Queiroz Muniz D, Nunes Filho PRS, Zaffaroni F, Barrios C, Fay A. The LACOG-0415 phase II trial: abiraterone acetate and ADT versus apalutamide versus abiraterone acetate and apalutamide in patients with advanced prostate cancer with non-castration testosterone levels. BMC Cancer 2019; 19:487. [PMID: 31122212 PMCID: PMC6533731 DOI: 10.1186/s12885-019-5709-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 05/14/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Testosterone suppression is the standard treatment for advanced prostate cancer, and it is associated with side-effects that impair patients' quality of life, like sexual dysfunction, osteoporosis, weight gain, and increased cardiovascular risk. We hypothesized that abiraterone acetate with prednisone (AAP) and apalutamide, alone or in combination, can be an effective hormonal therapy also possibly decreasing castration-associated side effects. METHODS Phase II, open-label, randomized, efficacy trial of abiraterone acetate plus prednisone (AAP) and Androgen Deprivation Therapy (ADT) versus apalutamide versus the combination of AAP (without ADT) and apalutamide. Key eligibility criteria are confirmed prostate adenocarcinoma; biochemical relapse after definitive treatment (PSA ≥ 4 ng/ml and doubling time less than 10 months, or PSA ≥ 20 ng/ml); newly diagnosed locally advanced or metastatic prostate cancer; asymptomatic to moderately symptomatic regarding bone symptoms. Patients with other histology besides adenocarcinoma or previous use of hormonal therapy or chemotherapy were excluded. DISCUSSION There is an urgent need to study and validate regimens such as new hormonal agents that may add benefit to castration with an acceptable safety profile. We aim to evaluate if apalutamide in monotherapy or in combination with AAP is an effective and safety hormonal treatment that can spare patients of androgen deprivation therapy. TRIAL REGISTRATION This trial was registered in ClinicalTrials.gov on October 16, 2017, under Identifier: NCT02867020.
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Affiliation(s)
- Gustavo Werutsky
- Latin American Cooperative Oncology Group, Ipiranga Avenue 6681, 99A, Room, Porto Alegre, 806 Brazil
| | | | | | | | | | - Fábio Peixoto
- Americas Centro de Oncologia Integrado, Rio de Janeiro, Brazil
| | - Oren Smaletz
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Fábio Schutz
- Beneficiência Portuguesa de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Paulo R. S. Nunes Filho
- Latin American Cooperative Oncology Group, Ipiranga Avenue 6681, 99A, Room, Porto Alegre, 806 Brazil
| | - Facundo Zaffaroni
- Latin American Cooperative Oncology Group, Ipiranga Avenue 6681, 99A, Room, Porto Alegre, 806 Brazil
| | - Carlos Barrios
- Latin American Cooperative Oncology Group, Ipiranga Avenue 6681, 99A, Room, Porto Alegre, 806 Brazil
| | - André Fay
- PUCRS School of Medicine, Porto Alegre, Brazil
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12
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Abstract
Prostate cancer remains the most common noncutaneous cancer in men, especially in this era of prostate-specific antigen assay. Prostate cancer metastases have been known to commonly affect the lymphatics, bones, and lungs. Prostate cancer metastasis to the skin is very rare (<1%) and often signifies a terminal disease. Involvement of the skin has been thought to be through lymphatic spread by embolization or permeation, hematogenous spread, and implantation during surgery (port site in radical prostatectomy). We report a 74-year-old man on management for advanced prostate cancer with subcutaneous goserelin (Zoladex) but developed skin metastasis in the course of treatment. The skin metastasis in our patient, however, was initially localized to the site of the regions of subcutaneous goserelin injection that we imagined if there is a link between the two. We reviewed the literature and currently found no connection. Is there truly a link?
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Affiliation(s)
- Timothy Uzoma Mbaeri
- Department of Surgery, Division of Urology, Nnamdi Azikiwe University, Awka, Nigeria
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13
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Heo JY, Yi H, Fava M, Mischoulon D, Kim K, Yoon S, Jeon HJ, Lee JE. Agoraphobia and Follicle-Stimulating Hormone Levels between Tamoxifen and Goserelin versus Tamoxifen Alone in Premenopausal Hormone Receptor-Positive Breast Cancer: A 12-Month Prospective Randomized Study. Psychiatry Investig 2017; 14:491-498. [PMID: 28845177 PMCID: PMC5561408 DOI: 10.4306/pi.2017.14.4.491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/17/2016] [Accepted: 08/24/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Tamoxifen is an estrogen receptor antagonist used to prevent recurrence of breast cancer, which may provoke depression and anxiety and increase follicle-stimulating hormone (FSH) to patients. We compared anxiety and depression symptoms and FSH levels who received conventional tamoxifen alone and combination treatment of goserelin, a gonadotropin-releasing hormone (GnRH) analogue, with tamoxifen. METHODS Sixty-four premenopausal women with hormone receptor-positive early-stage breast cancer were included and were assigned randomly to receive either tamoxifen and goserelin combination or tamoxifen alone for 12 months. The participants were evaluated blindly using the Hamilton Depression and Anxiety Rating Scale, the Beck Depression Rating Scale, and the Albany Panic and Phobia Questionnaire (APPQ). Blood FSH levels were assessed at baseline, 6 and 12 months. RESULTS A significant time×group difference was detected in the agoraphobia trends subscale of the APPQ and in FSH levels. The combination group showed significantly less increases in agoraphobia subscale of APPQ and greater decreases in FSH level than those in the tamoxifen-alone group from baseline to 12 months of treatment. No significant differences for age, tumor grade, body mass index, or family history were found at baseline between the two groups. CONCLUSION Our results suggest that the combination treatment of tamoxifen and goserelin resulted in less agoraphobia than tamoxifen alone in premenopausal women with breast cancer, which may associated with FSH suppression of goserelin.
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Affiliation(s)
- Jung-Yoon Heo
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hawoo Yi
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Yang Hospital, Namyangju, Republic of Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Kiwon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- National Institute of Dementia, Seongnam, Republic of Korea
| | - Sechang Yoon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Department of Health Sciences & Technology, Department of Medical Device Management and Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
| | - Jeong Eon Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences & Technology, Department of Medical Device Management and Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
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14
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Loibl S, Turner NC, Ro J, Cristofanilli M, Iwata H, Im SA, Masuda N, Loi S, André F, Harbeck N, Verma S, Folkerd E, Puyana Theall K, Hoffman J, Zhang K, Bartlett CH, Dowsett M. Palbociclib Combined with Fulvestrant in Premenopausal Women with Advanced Breast Cancer and Prior Progression on Endocrine Therapy: PALOMA-3 Results. Oncologist 2017; 22:1028-1038. [PMID: 28652278 DOI: 10.1634/theoncologist.2017-0072] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/23/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The efficacy and safety of palbociclib, a cyclin-dependent kinase 4/6 inhibitor, combined with fulvestrant and goserelin was assessed in premenopausal women with advanced breast cancer (ABC) who had progressed on prior endocrine therapy (ET). PATIENTS AND METHODS One hundred eight premenopausal endocrine-refractory women ≥18 years with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) ABC were among 521 women randomized 2:1 (347:174) to fulvestrant (500 mg) ± goserelin with either palbociclib (125 mg/day orally, 3 weeks on, 1 week off) or placebo. This analysis assessed whether the overall tolerable safety profile and significant progression-free survival (PFS) improvement extended to premenopausal women. Potential drug-drug interactions (DDIs) and ovarian suppression with goserelin were assessed via plasma pharmacokinetics and biochemical analyses, respectively. (ClinicalTrials.gov identifier: NCT01942135) RESULTS: Median PFS for premenopausal women in the palbociclib (n = 72) versus placebo arm (n = 36) was 9.5 versus 5.6 months, respectively (hazard ratio, 0.50, 95% confidence interval: 0.29-0.87), and consistent with the significant PFS improvement in the same arms for postmenopausal women. Any-grade and grade ≤3 neutropenia, leukopenia, and infections were among the most frequent adverse events reported in the palbociclib arm with concurrent goserelin administration. Hormone concentrations were similar between treatment arms and confirmed sustained ovarian suppression. Clinically relevant DDIs were not observed. CONCLUSION Palbociclib combined with fulvestrant and goserelin was an effective and well-tolerated treatment for premenopausal women with prior endocrine-resistant HR+/HER2- ABC. Inclusion of both premenopausal and postmenopausal women in pivotal combination ET trials facilitates access to novel drugs for young women and should be considered as a new standard for clinical trial design. IMPLICATIONS FOR PRACTICE PALOMA-3, the first registrational study to include premenopausal women in a trial investigating a CDK4/6 inhibitor combined with endocrine therapy, has the largest premenopausal cohort reported in an endocrine-resistant setting. In pretreated premenopausal women with hormone receptor-positive advanced breast cancer, palbociclib plus fulvestrant and goserelin (luteinizing hormone-releasing hormone [LHRH] agonist) treatment almost doubled median progression-free survival (PFS) and significantly increased the objective response rate versus endocrine monotherapy, achieving results comparable to those reported for chemotherapy without apparently interfering with LHRH agonist-induced ovarian suppression. The significant PFS gain and tolerable safety profile strongly support use of this regimen in premenopausal women with endocrine-resistant disease who could possibly delay chemotherapy.
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Affiliation(s)
- Sibylle Loibl
- German Breast Group GBG Forschungs GmbH, Neu-Isenburg, Germany
- Centre for Haematology and Oncology Bethanien, Frankfurt, Germany
| | | | - Jungsil Ro
- National Cancer Center, Goyang-si, South Korea
| | - Massimo Cristofanilli
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Norikazu Masuda
- Breast Oncology, NHO Osaka National Hospital, Osaka-city, Japan
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Nadia Harbeck
- Brustzentrum der Universität München (LMU), Munich, Germany
| | - Sunil Verma
- University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | | | | | | | - Ke Zhang
- Pfizer Inc., San Diego, California, USA
| | | | - Mitchell Dowsett
- Royal Marsden Hospital and Institute of Cancer Research, London, UK
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15
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Shen YC, Kang CH, Chiang PH. Efficacy of switching therapy of luteinizing hormone-releasing hormone analogue for advanced prostate cancer. Kaohsiung J Med Sci 2016; 32:567-571. [PMID: 27847099 DOI: 10.1016/j.kjms.2016.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/03/2016] [Accepted: 08/09/2016] [Indexed: 11/29/2022] Open
Abstract
This study was conducted to determine the efficacy of switching therapy with a second-line luteinizing hormone-releasing hormone (LHRH) analogue after prostate-specific antigen (PSA) progression for advanced prostate cancer. We enrolled 200 patients, from December 2005 to September 2013, with nodal positive, metastatic prostate cancer or disease progression after definite treatment receiving continuous LHRH analogue therapy with monthly depot leuprorelin(sc) acetate 3.75 mg/vial (LA) or goserelin acetate(sc) 3.6 mg/vial (GA). If the patients had castration-resistant prostate cancer, the treatment choice of switching therapy (from LA to GA or from GA to LA) prior to starting chemotherapy was given. The LH, testosterone level, and PSA change were recorded. The records showed that there were 127 patients receiving LA as initial ADT therapy, whereas the other 73 patients were in GA therapy. A total of 92 patients received LHRH analogue switching therapy (54 patients switched from LA to GA and 38 switched from GA to LA). The effect of LH and testosterone reduction prior to and after switching therapy was comparable between the two groups, and increased PSA level after 3 months of treatment was seen in both groups (median PSA: 15.7-67.7 ng/mL in the LA to GA group; 15.2-71.4 ng/mL in the GA to LA group). This study concluded that switching therapy for patients with PSA progression after ADT has no efficacy of further PSA response.
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Affiliation(s)
- Yuan-Chi Shen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Cheng Shiu University, Kaohsiung, Taiwan
| | - Chih-Hsiung Kang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Po-Hui Chiang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
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16
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Alramadhan M, Ryu JM, Rayzah M, Nam SJ, Kim SW, Yu J, Lee SK, Bae SY, Park S, Paik HJ, Lee JE. Goserelin plus tamoxifen compared to chemotherapy followed by tamoxifen in premenopausal patients with early stage-, lymph node-negative breast cancer of luminal A subtype. Breast 2016; 30:111-117. [PMID: 27697675 DOI: 10.1016/j.breast.2016.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 08/02/2016] [Accepted: 08/18/2016] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To study the outcomes of adjuvant goserelin combined with tamoxifen (GosTam) compared to chemotherapy followed by tamoxifen (ChemTam) in premenopausal patients with early stage, luminal A breast cancer. METHODS From 2008 until 2013, data were retrospectively collected for premenopausal patients who underwent surgery for invasive tumors that were ≤2.0 cm, node-negative, strongly positive for estrogen and progesterone receptors, HER-2-negative, and Ki-67 < 25%. The patients were divided into two groups according to adjuvant regimen, either GosTam or ChemTam. All patients who underwent different adjuvant regimens were excluded. RESULTS In total, 235 patients underwent GosTam and 171 patients underwent ChemTam. There were significantly more patients younger than 40 years in the GosTam group (32% GosTam vs. 22% ChemTam, p = 0.031). Mean tumor size was significantly smaller (1.19 cm vs. 1.48 cm, p < 0.001), Ki-67 significantly lower (p = 0.049), and nuclear grade was low in a significant number of patients in the GosTam group (2% vs. 13%, p < 0.001). After a median follow-up of 51.3 months, there was no mortality in either group. There was no significant difference in 5-year disease-free survival (DFS) between the two groups even after univariate analysis considering age, tumor size, nuclear grade, and P53% (GosTam = 98.9% vs. ChemTam = 95.7%, HR = 0.404, 95% CI = [0.073, 2.222], p = 0.248). CONCLUSION There was no difference between treatment groups, and neither chemotherapy nor ovarian suppression seemed to improve the outcome. Thus, tamoxifen alone might be a sufficient option for this low-risk patient population.
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Affiliation(s)
- Mansoor Alramadhan
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Jai Min Ryu
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Musaed Rayzah
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Seok Jin Nam
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Seok Won Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Jonghan Yu
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Se Kyung Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Soo Youn Bae
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Sungmin Park
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Hyun-June Paik
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Jeong Eon Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea.
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17
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Kim HA, Ahn SH, Nam SJ, Park S, Ro J, Im SA, Jung YS, Yoon JH, Hur MH, Choi YJ, Lee SJ, Jeong J, Cho SH, Kim SY, Lee MH, Kim LS, Moon BI, Kim TH, Park C, Kim SJ, Jung SH, Park H, Gwak GH, Kang SH, Kim JG, Kim J, Choi SY, Lim CW, Kim D, Yoo Y, Song YJ, Kang YJ, Jung SS, Shin HJ, Lee KJ, Han SH, Lee ES, Han W, Kim HJ, Noh WC. The role of the addition of ovarian suppression to tamoxifen in young women with hormone-sensitive breast cancer who remain premenopausal or regain menstruation after chemotherapy (ASTRRA): study protocol for a randomized controlled trial and progress. BMC Cancer 2016; 16:319. [PMID: 27197523 PMCID: PMC4872354 DOI: 10.1186/s12885-016-2354-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/11/2016] [Indexed: 01/24/2023] Open
Abstract
Background Ovarian function suppression (OFS) has been shown to be effective as adjuvant endocrine therapy in premenopausal women with hormone receptor-positive breast cancer. However, it is currently unclear if addition of OFS to standard tamoxifen therapy after completion of adjuvant chemotherapy results in a survival benefit. In 2008, the Korean Breast Cancer Society Study Group initiated the ASTRRA randomized phase III trial to evaluate the efficacy of OFS in addition to standard tamoxifen treatment in hormone receptor-positive breast cancer patients who remain or regain premenopausal status after chemotherapy. Methods Premenopausal women with estrogen receptor-positive breast cancer treated with definitive surgery were enrolled after completion of neoadjuvant or adjuvant chemotherapy. Ovarian function was assessed at the time of enrollment and every 6 months for 2 years by follicular-stimulating hormone levels and bleeding history. If ovarian function was confirmed as premenopausal status, the patient was randomized to receive 2 years of goserelin plus 5 years of tamoxifen treatment or 5 years of tamoxifen alone. The primary end point will be the comparison of the 5-year disease-free survival rates between the OFS and tamoxifen alone groups. Patient recruitment was finished on March 2014 with the inclusion of a total of 1483 patients. The interim analysis will be performed at the time of the observation of the 187th event. Discussion This study will provide evidence of the benefit of OFS plus tamoxifen compared with tamoxifen only in premenopausal patients with estrogen receptor-positive breast cancer treated with chemotherapy. Trial registration ClinicalTrials.gov Identifier NCT00912548. Registered May 31 2009. Korean Breast Cancer Society Study Group Register KBCSG005. Registered October 26 2009.
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Affiliation(s)
- Hyun-Ah Kim
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Sei Hyun Ahn
- Department of Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Seok Jin Nam
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of medicine, Seoul, Republic of Korea
| | - Seho Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jungsil Ro
- Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Sik Jung
- Department of Surgery, Ajou University, School of Medicine, Suwon, Republic of Korea
| | - Jung Han Yoon
- Department of Surgery, Chonnam National University Hwasun Hospital, Gwangju, Republic of Korea
| | - Min Hee Hur
- Department of Surgery, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea
| | - Yoon Ji Choi
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Soo-Jung Lee
- Department of Surgery, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University, Seoul, Republic of Korea
| | - Se-Heon Cho
- Department of Surgery, Dong-A University Hospital, Busan, Republic of Korea
| | - Sung Yong Kim
- Department of Surgery, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea
| | - Min Hyuk Lee
- Department of Surgery, Soonchunhyang University Colleage of Medicine, Seoul, Republic of Korea
| | - Lee Su Kim
- Division of Breast & Endocrine Surgery, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Republic of Korea
| | - Byung-In Moon
- Department of Surgery, Mokdong Hospital, Ewha Womans University, Seoul, Republic of Korea
| | - Tae Hyun Kim
- Department of Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Chanheun Park
- Department of Surgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Sei Joong Kim
- Department of Surgery, Inha University Hospital, Inha University, Incheon, Republic of Korea
| | - Sung Hoo Jung
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Heungkyu Park
- Department of Breast Surgery, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Geum Hee Gwak
- Department of Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Sun Hee Kang
- Department of Surgery, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Jong Gin Kim
- Departments of Surgery, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jeryong Kim
- Department of Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Su Yun Choi
- Department of Surgery, KangDong sacred heart hospital, Hallym university, Seoul, Republic of Korea
| | - Cheol-Wan Lim
- Department of Surgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Doyil Kim
- Department of Surgery, Kangseo Mizmedi Hospital, Seoul, Republic of Korea
| | - Youngbum Yoo
- Department of Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Young-Jin Song
- Department of Surgery, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Republic of Korea
| | - Yoon-Jung Kang
- Department of Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Sang Seol Jung
- Department of Surgery, Seoul St. Mary's Hospital, Medical College of The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyuk Jai Shin
- Breast and thyroid care center, Department of Surgery, Myongji Hospital, Goyang, Republic of Korea
| | - Kwan Ju Lee
- Department of Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Se-Hwan Han
- Department of Surgery, Ajou University, School of Medicine, Suwon, Republic of Korea
| | - Eun Sook Lee
- Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Wonshik Han
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee-Jung Kim
- Department of Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Woo Chul Noh
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea.
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Abo El-Enen M, Tawfik A, El-Abd AS, Ragab M, El-Abd S, Elrashidy M, Elmashad N, Rasheed M, El-Abd S. Goserelin acetate before transurethral resection of moderately enlarged benign prostatic hyperplasia: Prospective randomised-controlled clinical trial. Arab J Urol 2016; 14:59-65. [PMID: 26966595 PMCID: PMC4767797 DOI: 10.1016/j.aju.2015.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/16/2015] [Accepted: 09/21/2015] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the impact of a luteinising hormone-releasing hormone (LHRH) agonist, goserelin acetate (GA), on surgical blood loss during transurethral resection of the prostate (TURP), as well as its histopathological effect on prostatic microvessel density (MVD). Patients and methods Patients who underwent TURP due to benign prostatic enlargement (60–100 mL) were randomly subdivided into two equal groups according to whether they received preoperative GA administration (3.6 mg; group A) or not (group B). Evaluation parameters were operative time, weight of resected prostatic tissue, perioperative haematocrit (HCT) changes, estimation of intraoperative blood loss, and suburethral and stromal prostatic MVD. Effects of GA on prostate weight and any possible side-effects were also monitored. Results In all, 35 and 33 patients were included in groups A and B, respectively. Operative time and HCT values’ changes were significantly less in group A (P < 0.05). Also, operative blood loss (both total and adjusted per weight of resected tissue) was lower in group A, at a mean (SD) of 178.13 (77.71) mL and 3.74 (1.52) mL/g vs 371.75 (91.09) mL and 8.59 (2.42) mL/g (P < 0.001). The median MVD in both suburethral [8 vs 11 vessels/high-power field (HPF)] and stromal tissues (9 vs 17 vessels/HPF) were significantly lower in group A (P < 0.001). Side-effects were minimal. Conclusion A single dose of GA, a LHRH agonist, before TURP is safe and effective in reducing surgical blood loss. It significantly reduced MVD in both suburethral and stromal nodular prostatic tissues without regional discrepancy.
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Key Words
- 5ARI, 5α-reductase inhibitor
- BPE, benign prostatic enlargement
- BPH
- Blood loss
- CBC, complete blood count
- DHT, dihydrotestosterone
- GA, goserelin acetate
- Goserelin
- HCT, haematocrit
- HPF, high-power field
- LHRH
- MVD, microvessel density
- MVD-stroma, stromal MVD
- MVD-sub, suburethral MVD
- TRUS-PV, TRUS prostate volume
- TURP
- VEGF, vascular endothelial growth factor
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Affiliation(s)
| | - Ahmed Tawfik
- Departments of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed S El-Abd
- Departments of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Maged Ragab
- Departments of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sherin El-Abd
- Departments of Histology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Elrashidy
- Departments of Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Nehal Elmashad
- Departments of Medical Oncology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Rasheed
- Departments of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Shawky El-Abd
- Departments of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Wilson C, Gossiel F, Leonard R, Anderson RA, Adamson DJA, Thomas G, Coleman RE. Goserelin, as an ovarian protector during (neo)adjuvant breast cancer chemotherapy, prevents long term altered bone turnover. J Bone Oncol 2016; 5:43-9. [PMID: 26998426 PMCID: PMC4782022 DOI: 10.1016/j.jbo.2016.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/01/2016] [Accepted: 02/06/2016] [Indexed: 01/20/2023] Open
Abstract
Background The Ovarian Protection Trial In Premenopausal Breast Cancer Patients “OPTION” trial (NCT00427245) was a prospective, multicenter, randomised, open label study evaluating the frequency of primary ovarian insufficiency (POI) at 12 months in women randomised to 6–8 cycles of (neo)adjuvant chemotherapy (CT) +/− goserelin (G). Here we report the results of a secondary endpoint analysis of the effects of CT+/-G on markers of bone turnover. Methods Serum for bone alkaline phosphatase (BALP) and urine for N-terminal telopeptide (NTX) were collected at baseline, 6, 12, 18, 24 and 36 months. Changes in median levels of bone turnover markers were evaluated for the overall population, according to age stratification at randomisation (≤40 vs >40 years) and with exploratory analysis according to POI rates at 12 months. Results In the overall population, there was a significant increase in NTX at 6 months compared to baseline in patients treated with CT+G (40.81 vs 57.82 p=0.0074) with normalisation of levels thereafter. BALP was significantly increased compared to baseline at 6 months and 12 months in those receiving CT+G, but normalised thereafter. BALP remained significantly higher compared to baseline at 12, 24 and 36 months in patients receiving CT, resulting in a significant difference between treatment groups at 36 months (CT+G 5.845 vs CT 8.5 p=0.0006). These changes were predominantly seen in women >40 years. Women with POI at 12 months showed altered bone formation compared to baseline levels for a longer duration than women who maintained menses. Conclusion Addition of G to CT increases bone turnover during treatment with normalisation after cessation of treatment suggesting G may offer sufficient ovarian protection against CT induced POI to negate longstanding altered bone turnover associated with POI.
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Affiliation(s)
- Caroline Wilson
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, United Kingdom
| | - Fatma Gossiel
- Mellanby Centre for Bone research, Sheffield Medical School, University of Sheffield, Sheffield, United Kingdom
| | | | - Richard A Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Douglas J A Adamson
- Ninewells Hospital and Medical School, Ward 32, University of Dundee, Dundee, United Kingdom
| | | | - Robert E Coleman
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, United Kingdom
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Shin MS, Chung KJ, Ko IG, Kim SH, Jin JJ, Kim SE, Lee JM, Ji ES, Kim TW, Cho HS, Kim CH, Cho YS, Kim CJ, Kim KH. Effects of surgical and chemical castration on spatial learning ability in relation to cell proliferation and apoptosis in hippocampus. Int Urol Nephrol 2016; 48:517-27. [PMID: 26781653 DOI: 10.1007/s11255-015-1200-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/23/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Chemical castration using luteinizing hormone-releasing hormone agonists and/or anti-androgens is an alternative to surgical castration. Goserelin and bicalutamide are representative drugs used for chemical castration. The effects of chemical castration on sexual functions are well documented; however, the possibility that chemical castration might induce undesirable effects on brain functions has been raised. We investigated the effects of chemical castration and surgical castration on spatial learning ability in relation to cell proliferation and apoptosis in hippocampus. METHODS Bilateral orchiectomy was performed for surgical castration, and chemical castration was induced by treatment with goserelin or bicalutamide for 28 days. To find out the effects of goserelin and bicalutamide with those of orchiectomy on the spatial learning ability, radial eight-arm maze test was performed. To find out the effects of goserelin and bicalutamide with those of orchiectomy in relation to cell proliferation and apoptosis in the hippocampus, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling staining, and immunohistochemistry for 5-bromo-2'-deoxyuridine, doublecortin, and caspase-3 were performed. Western blot for brain-derived neurotrophic factor, tyrosine kinase receptor B, Bax, and Bcl-2 in the hippocampus was also performed. RESULTS Orchiectomy caused deterioration of spatial learning ability with suppression of cell proliferation and enhancement of apoptosis in the hippocampus. However, treatment with goserelin and bicalutamide had no effect on spatial learning ability. Cell proliferation and apoptosis were not altered by treatment with goserelin and bicalutamide either. CONCLUSIONS Surgical castration causes deterioration of spatial learning ability, while chemical castration does not impair spatial learning ability. We should find out further mechanisms affect to the relationship between androgen level and neurogenesis and neuronal apoptosis.
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Affiliation(s)
- Mal-Soon Shin
- Department of Physiology, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Kyung Jin Chung
- Department of Urology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, 405-760, Republic of Korea
| | - Il-Gyu Ko
- Department of Physiology, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Sang-Hoon Kim
- Department of Physiology, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Jun-Jang Jin
- Department of Physiology, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Sung-Eun Kim
- Department of Physiology, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Jae-Min Lee
- Department of Physiology, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Eun-Sang Ji
- Department of Physiology, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Tae-Woon Kim
- Department of Physiology, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Han-Sam Cho
- Department of Physiology, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Chang Hee Kim
- Department of Urology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, 405-760, Republic of Korea
| | - Young-Sam Cho
- Department of Urology, School of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Jongro-gu, Seoul, 110-746, Republic of Korea
| | - Chang-Ju Kim
- Department of Physiology, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, 130-701, Republic of Korea
| | - Khae-Hawn Kim
- Department of Urology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, 405-760, Republic of Korea.
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Hosseini SA, Rajabi F, Akbari Sari A, Ayati M, Heidari S, Ghamary F. Degarelix for the treatment of advanced prostate cancer compared with GnRh-Agonists: a systematic review and meta-analysis. Med J Islam Repub Iran 2016; 30:317. [PMID: 27390687 PMCID: PMC4898839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/08/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Hormone therapy is currently the mainstay in the management of locally advanced and metastatic prostate cancer. We performed a systematic review to compare safety, efficacy and effectiveness of degarelix, a new gonadotropin-releasing hormone (GnRH) antagonist (blocker), versus gonadotropin-releasing hormone (GnRH) agonists. METHODS MEDLINE, Web of Science and the Cochrane library were searched to identify all of the published Randomized Controlled Trials (RCTs) that used degarelix versus gonadotropin-releasing hormone agonists with or without anti-androgen therapy for the treatment of prostate cancer. We performed meta-analysis of extracted data on safety and efficacy of the target medication. RESULTS Six studies were included. They involved a total of 2296 patients which were used in the meta-analysis. Follow-up times after treatment were between 12 weeks and 12 months. Three of six RCTs compared degarelix with goserelin and the others compared it with leuprolide. Meta-analysis on safety outcomes revealed that the only statistically significant difference between the degarelix treated group and GnRH agonists treated group was complication in the injection site which was higher in degarelix-treated group (OR= 46.34, 95% CI: 15.79 to 136, p<0.001). Although general mortality rate was lower in degarelix-treated group (OR= 2.06, 95% CI: 1.08 to 3.93, p=0.03); mortality due to the drug side effects was not different. Meta-analysis of efficacy data also showed that International Prostate Symptom Score (IPSS) reduction at week 12, (MD=-1.85, 95% CI: -2.97 to - 0.72, p=0.001) and Testosterone reduction between day 1-28, (OR=11.58, 95% CI: 5.77 to 23.22, p<0.001) was statistically higher in degarelix-treated group. Testosterone reduction after day 28 and prostate volume reduction did not have significant difference. CONCLUSION Our meta-analysis indicates that, compared with GnRH agonists, degarelix has significantly more effects on lower urinary tract symptoms and also Prostate Specific Antigen (PSA) and testosterone reduction in the first month of the treatment. Except minor complications in the injection site like pain, erythema and swelling, there is no increase in major side effects and mortality due to degarelix. This is while the effect on testosterone and PSA after the first month of treatment is not statistically different between the two groups.
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Affiliation(s)
- Seyed Alireza Hosseini
- 1 Associate Professor, Food and Drug Research Center, Clinical Trials Group, Iran Food and Drug Administration, Tehran, Iran. .
| | - Fatemeh Rajabi
- 2 Assistant Professor in Community Medicine, Community Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, & Center for Academic and Health Policy, Tehran University of Medical Sciences, Tehran, Iran. ,(Corresponding author) Assistant Professor in Community Medicine, Community Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, & Center for Academic and Health Policy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Akbari Sari
- 3 Associate Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. .
| | - Mohsen Ayati
- 4 Associate Professor of Urology, Department of Urology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran..
| | - Saeed Heidari
- 5 MSc, Health Technology Assessment, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Fawzieh Ghamary
- 6 MSc, Health Technology Assessment, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. .
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Noguchi S, Kim HJ, Jesena A, Parmar V, Sato N, Wang HC, Lokejaroenlarb S, Isidro J, Kim KS, Itoh Y, Shin E. Phase 3, open-label, randomized study comparing 3-monthly with monthly goserelin in pre-menopausal women with estrogen receptor-positive advanced breast cancer. Breast Cancer 2015; 23:771-9. [PMID: 26350351 PMCID: PMC4999470 DOI: 10.1007/s12282-015-0637-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/20/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Monthly goserelin 3.6 mg dosing suppresses estradiol (E2) production and has proven efficacy in pre-menopausal women with estrogen receptor (ER)-positive breast cancer. This non-inferiority study evaluated the efficacy and safety of 3-monthly goserelin 10.8 mg compared with monthly goserelin 3.6 mg. METHODS This was a Phase 3, open-label, multicenter trial. Pre-menopausal women with ER-positive advanced breast cancer were randomized to 3-monthly goserelin 10.8 mg or monthly goserelin 3.6 mg; all patients received concomitant tamoxifen (20 mg daily). The primary endpoint was progression-free survival (PFS) rate at 24 weeks; non-inferiority was to be confirmed if the entire 95 % confidence interval (CI) for the treatment difference was above -17.5 %. Secondary endpoints included objective response rate (ORR), serum E2 levels, safety, and tolerability. RESULTS In total, 222 patients were randomized (goserelin 10.8 mg, n = 109; goserelin 3.6 mg, n = 113). PFS rate at week 24 was 61.5 % (goserelin 10.8 mg) and 60.2 % (goserelin 3.6 mg); treatment difference (95 % CI) was 1.3 % (-11.4, 13.9), confirming non-inferiority of goserelin 10.8 mg compared with goserelin 3.6 mg. ORR was 23.9 % (goserelin 10.8 mg) and 26.9 % (goserelin 3.6 mg); treatment difference (95 % CI) was -3.0 % (-15.5, 9.7). At week 24, mean serum E2 concentrations were similar in the goserelin 10.8 mg and goserelin 3.6 mg groups (20.3 pg/mL and 24.8 pg/mL, respectively). CONCLUSION A regimen of 3-monthly goserelin 10.8 mg demonstrated non-inferiority compared with monthly goserelin 3.6 mg for PFS rate at 24 weeks, with similar pharmacodynamic and safety profiles, in pre-menopausal women with ER-positive breast cancer.
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Affiliation(s)
- Shinzaburo Noguchi
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
| | - Hee Jeong Kim
- Department of Surgery, Asan Medical Center, Seoul, Korea
| | | | - Vani Parmar
- Breast Disease Management Group, Tata Memorial Hospital, Mumbai, India
| | - Nobuaki Sato
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Hwei-Chung Wang
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | | | - Jofel Isidro
- Great Saviour International Hospital, Iloilo, Philippines
| | - Ku Sang Kim
- Department of Breast and Thyroid Surgery, Ulsan City Hospital, Ulsan, Korea
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Zhou J, Wu SG, Wang JJ, Sun JY, Li FY, Lin Q, Lin HX, He ZY. Ovarian Ablation Using Goserelin Improves Survival of Premenopausal Patients with Stage II/III Hormone Receptor-Positive Breast Cancer without Chemotherapy-Induced Amenorrhea. Cancer Res Treat 2014; 47:55-63. [PMID: 25187267 PMCID: PMC4296851 DOI: 10.4143/crt.2013.165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/16/2013] [Indexed: 12/29/2022] Open
Abstract
Purpose The purpose of this study was to assess the value of ovarian ablation using goserelin in premenopausal patients with stage II/III hormone receptor-positive breast cancer without chemotherapy-induced amenorrhea (CIA). Materials and Methods We retrospectively reviewed the data of breast patients treated between October 1999 and November 2007 without CIA. The Kaplan-Meier method was used for calculation of the survival rate. Log rank method and Cox regression analysis were used for univariate and multivariate prognostic analysis. Results The median follow-up period was 61 months. Initially, 353 patients remained without CIA after chemotherapy and 98 among those who received goserelin and tamoxifen (TAM). In univariate analysis, goserelin improved locoregional recurrence-free survival (LRFS) (98.9% vs. 94.1%, p=0.041), distant metastasis-free survival (DMFS) (85.4% vs. 71.9%, p=0.006), disease-free survival (DFS) (85.4% vs. 71.6%, p=0.005), and overall survival (OS) (93.5% vs. 83.5%, p=0.010). In multivariate analysis, goserelin treatment was an independent factor influencing DMFS (hazard ratio [HR], 1.603; 95% confidence interval [CI], 1.228 to 2.092; p=0.001), DFS (HR, 1.606; 95% CI, 1.231 to 2.096; p=0.001), and OS (HR, 3.311; 95% CI, 1.416 to 7.742; p=0.006). In addition, treatment with goserelin resulted in significantly improved LRFS (p=0.039), DMFS (p=0.043), DFS (p=0.036), and OS (p=0.010) in patients aged < 40 years. In patients aged ≥ 40 years, goserelin only improved DMFS (p=0.028) and DFS (p=0.027). Conclusion Ovarian ablation with goserelin plus TAM resulted in significantly improved therapeutic efficacy in premenopausal patients with stage II/III hormone receptor-positive breast cancer without CIA.
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Affiliation(s)
- Juan Zhou
- Departments of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - San-Gang Wu
- Departments of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jun-Jie Wang
- Department of Medical Oncology, The Central Hospital of Xinxiang, Xinxiang, China
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Feng-Yan Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Qin Lin
- Departments of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Huan-Xin Lin
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
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Klotz L, Miller K, Crawford ED, Shore N, Tombal B, Karup C, Malmberg A, Persson BE. Disease control outcomes from analysis of pooled individual patient data from five comparative randomised clinical trials of degarelix versus luteinising hormone-releasing hormone agonists. Eur Urol. 2014;66:1101-1108. [PMID: 24440304 DOI: 10.1016/j.eururo.2013.12.063] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 12/27/2013] [Indexed: 01/14/2023]
Abstract
BACKGROUND Studies comparing the gonadotropin-releasing hormone antagonist, degarelix, with luteinising hormone-releasing hormone (LHRH) agonists indicate differences in outcomes. OBJECTIVE To assess differences in efficacy and safety outcomes in a pooled analysis of trials comparing degarelix with LHRH agonists. DESIGN, SETTING, AND PARTICIPANTS Data were pooled from five prospective, phase 3 or 3b randomised trials (n=1925) of degarelix and leuprolide or goserelin in men requiring androgen deprivation therapy for the treatment of prostate cancer. Patients received either 3 mo (n=467) or 12 mo (n=1458) of treatment. INTERVENTION Men were randomised to receive degarelix (n=1266), leuprolide (n=201), or goserelin (n=458). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Unadjusted Kaplan-Meier analyses were supported by the Cox proportional hazards model, adjusted for disease-related baseline factors, to estimate hazard ratios (HRs) of efficacy and safety outcomes. The Fisher exact test compared crude incidences of adverse events. RESULTS AND LIMITATIONS Prostate-specific antigen (PSA) progression-free survival (PFS) was improved in the degarelix group (HR: 0.71; p=0.017). For patients with baseline PSA levels >20 ng/ml, the HR for PSA PFS was 0.74 (p=0.052). Overall survival (OS) was higher in the degarelix group (HR: 0.47; p=0.023). OS was particularly improved with degarelix in patients with baseline testosterone levels >2 ng/ml (HR: 0.36; p=0.006). In terms of disease-related adverse events, there were, overall, fewer joint-related signs and symptoms, musculoskeletal events, and urinary tract events in the degarelix group. CONCLUSIONS These data indicate clinical benefits with degarelix, including a significant improvement in PSA PFS and OS, as well as reduced incidence of joint, musculoskeletal, and urinary tract adverse events, compared with LHRH agonists.
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