Skip survey header

PROSCA 2020 case 3 - Tombal

Thank You!

Your case challenge

View case
 
What would Bertrand Tombal do?



Gonadotropin-releasing hormone antagonists (GnRH antagonists) have been shown to reduce the incidence of a new cardiovascular (CV) event in patients with a previous history of CV disease (myocardial ischaemia, coronary artery disease, myocardial infarction, cerebrovascular accident, angina pectoris or coronary artery bypass at baseline).

This was first observed in a metanalysis of 5 randomised trials comparing degarelix to a luteinizing hormone–releasing hormone agonist (LHRH agonist). The hazard ratio for the probability of a severe CV event or death while on ADT was 0.44 in favour of degarelix [Albertsen PC, et al. Eur Urol 2014;65:565–73].

This was subsequently confirmed by a randomised phase 2 study conducted by David Margel in patients with a previous history of CV disease: in the year following initiation of ADT 8/30 patients receiving an agonist experienced a major CV and cerebrovascular event (MACCE) vs 1/41 that received degarelix [Margel D, et al. J Urol 2019:202:1199-1208].

More recently, in the relugolix registration trial HERO, the odds ratio for experiencing a MACCE for leuprolide vs relugolix was 5.8 in patients with a previous history of MACCE; in that subgroup 17.9% of the patients receiving leuprolide experienced a MACCE vs 3.6% with relugolix [Shore ND, et al. New Engl J Med 2020;382:2187-96].

This should definitively settle the role of GnRH antagonists for ADT in men with previous CV disease.
 

What would Bertrand Tombal do?

Gonadotropin-releasing hormone antagonists (GnRH antagonists) have been shown to reduce the incidence of a new cardiovascular (CV) event in patients with a previous history of CV disease (myocardial ischaemia, coronary artery disease, myocardial infarction, cerebrovascular accident, angina pectoris or coronary artery bypass at baseline).

This was first observed in a metanalysis of 5 randomised trials comparing degarelix to a luteinizing hormone–releasing hormone agonist (LHRH agonist). The hazard ratio for the probability of a severe CV event or death while on ADT was 0.44 in favour of degarelix [Albertsen PC, et al. Eur Urol 2014;65:565–73].

This was subsequently confirmed by a randomised phase 2 study conducted by David Margel in patients with a previous history of CV disease: in the year following initiation of ADT 8/30 patients receiving an agonist experienced a major CV and cerebrovascular event (MACCE) vs 1/41 that received degarelix [Margel D, et al. J Urol 2019:202:1199-1208].

More recently, in the relugolix registration trial HERO, the odds ratio for experiencing a MACCE for leuprolide vs relugolix was 5.8 in patients with a previous history of MACCE; in that subgroup 17.9% of the patients receiving leuprolide experienced a MACCE vs 3.6% with relugolix [Shore ND, et al. New Engl J Med 2020;382:2187-96].

This should definitively settle the role of GnRH antagonists for ADT in men with previous CV disease.
 
I hope you can join us during the live panel discussion of virtual PROSCA 2020 on 14 October to further discuss these data.
Reserve your seat