Prostate Cancer: Enough 'Me Too’ Drugs

Stéphane Oudard, MD, PhD; Bertrand Tombal, MD, PhD


October 09, 2013

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Stéphane Oudard, MD, PhD: Hello. I am Stéphane Oudard, Professor of Medicine at Paris Descartes University, and Chief of the Department of Oncology at the Georges Pompidou Hospital in Paris, France. Welcome to Medscape Oncology Insights on prostate cancer, coming to you from the 2013 European Cancer Congress in Amsterdam. Joining me is Professor Bertrand Tombal, Professor of Urology at the Université Catholique de Louvain and Chairman of the Urology Service at the Cliniques Universitaires Saint Luc in Brussels, Belgium. Welcome, Bertrand. It is nice to have you on board, and I would like to ask you if you could present your data on degarelix.[1] It is a very nice study. What are your feelings about this topic and these studies so far?

Degarelix Reduces Cardiovascular Toxicity

Bertrand Tombal, MD, PhD: As a urologist, I believe that we have somewhat different challenges in that we use the drug very early on. It is important that we also tackle some issues occurring earlier in the course of disease. All of these patients receive hormone therapy at some point, and we have realized for the past 5 years that it increases the risk for cardiovascular disease. One reason that we have not been successful is that many patients died from cardiovascular disease rather than from prostate cancer. This is not the case in castration resistance, but earlier in the disease it is true, so there has been a lot of activity --trying on one side to increase the efficacy of hormone therapy, but on the other side trying to reduce the toxicity of the hormone that may lead to cardiovascular toxicity, as highlighted by the US Food and Drug Administration in 2010.

We are trying to pursue 2 different tracks. The first is to promote luteinizing hormone-releasing hormone (LHRH) antagonists instead of LHRH agonists -- drugs such as degarelix. They have a different mode of action, and we have noticed in the large pool (it is not really a meta-analysis; it is more a combined analysis of several trials) that in patients who previously experienced cardiovascular disease before starting hormone therapy we reduced the risk by 50%, so we believe that for that specific category of patient (namely, those who experienced myocardial infarction, stroke, etc.) that using an antagonist instead of an agonist may help reduce the risk for subsequent cardiovascular events.

The other track, as reported by Matthew Smith,[2] is to promote a new generation of antiandrogens, such as enzalutamide, in patients who have never received hormone therapy, because clearly we may achieve similar results. Although it is a phase 2 trial, it still has to be conducted in other stages of the disease with no or minor impact on metabolism.


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