Davide Meani1, Mladen Solarić2, Harri Visapää3, Rose-Marie Rosén4, Robert Janknegt5, Majana Soče2. 1. Hexal AG, Industriestr. 25, D-83607, Holzkirchen, Germany. 2. Department of Oncology, University Hospital Center Zagreb (KBC Zagreb), Croatia. 3. Department of Radiotherapy, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland. 4. Department of Urology, Skåne University Hospital, Malmö, Sweden. 5. Department of Clinical Pharmacy and Toxicology, Zuyderland Medisch Centrum, Sittard-Geleen, The Netherlands.
Abstract
BACKGROUND: Androgen deprivation therapy (ADT) with luteinizing hormone-releasing hormone (LHRH) agonists is well established for the treatment of men with metastatic prostate cancer. As clear differences in efficacy, safety, or tolerability between the available LHRH agonists are lacking, the healthcare management team needs to look to practical differences between the formulations when selecting therapy for their patients. Moreover, as the economic burden of prostate cancer rises alongside earlier diagnosis and improved survival, the possibility for cost savings by using products with specific features is growing in importance. METHODS: A review was conducted to summarize the information on the different LHRH agonist formulations currently available and offer insight into their relative benefits and disadvantages from the perspectives of physicians, a pharmacist, and a nurse. RESULTS: The leuprorelin acetate and goserelin acetate solid implants have the advantage of being ready to use with no requirement for refrigeration, whereas powder and microsphere formulations have to be reconstituted and have specific storage or handling constraints. The single-step administration of solid implants, therefore, has potential to reduce labor time and associated costs. Dosing frequency is another key consideration, as administering the injection provides an opportunity for face-to-face interaction between the patient and healthcare professionals to ensure therapy is optimized and give reassurance to patients. Prostate cancer patients are reported to prefer 3- or 6-monthly dosing, which aligns with the monitoring frequency recommended in European Association of Urology guidelines and has been shown to result in reduced annual costs compared with 1-month formulations. CONCLUSIONS: A number of practical differences exist between the different LHRH agonist preparations available, which may impact on clinical practice. It is important for healthcare providers to be aware and carefully consider these differences when selecting treatments for their prostate cancer patients.
BACKGROUND: Androgen deprivation therapy (ADT) with luteinizing hormone-releasing hormone (LHRH) agonists is well established for the treatment of men with metastatic prostate cancer. As clear differences in efficacy, safety, or tolerability between the available LHRH agonists are lacking, the healthcare management team needs to look to practical differences between the formulations when selecting therapy for their patients. Moreover, as the economic burden of prostate cancer rises alongside earlier diagnosis and improved survival, the possibility for cost savings by using products with specific features is growing in importance. METHODS: A review was conducted to summarize the information on the different LHRH agonist formulations currently available and offer insight into their relative benefits and disadvantages from the perspectives of physicians, a pharmacist, and a nurse. RESULTS: The leuprorelin acetate and goserelin acetate solid implants have the advantage of being ready to use with no requirement for refrigeration, whereas powder and microsphere formulations have to be reconstituted and have specific storage or handling constraints. The single-step administration of solid implants, therefore, has potential to reduce labor time and associated costs. Dosing frequency is another key consideration, as administering the injection provides an opportunity for face-to-face interaction between the patient and healthcare professionals to ensure therapy is optimized and give reassurance to patients. Prostate cancer patients are reported to prefer 3- or 6-monthly dosing, which aligns with the monitoring frequency recommended in European Association of Urology guidelines and has been shown to result in reduced annual costs compared with 1-month formulations. CONCLUSIONS: A number of practical differences exist between the different LHRH agonist preparations available, which may impact on clinical practice. It is important for healthcare providers to be aware and carefully consider these differences when selecting treatments for their prostate cancer patients.
Authors: J Seidenfeld; D J Samson; V Hasselblad; N Aronson; P C Albertsen; C L Bennett; T J Wilt Journal: Ann Intern Med Date: 2000-04-04 Impact factor: 25.391
Authors: J M Kuhn; H Abourachid; P Brucher; J C Doutres; J Fretin; A Jaupitre; R Jorest; D Lambert; J Petit; J Pin; J Blumberg; F Dufour-Esquerré Journal: Eur Urol Date: 1997 Impact factor: 20.096
Authors: Aaron Spitz; Marc Gittelman; Lawrence I Karsh; Sanja Dragnic; Ahmed M Soliman; Aditya Lele; Damian Gruca; Michael Norton Journal: Res Rep Urol Date: 2016-08-23
Authors: Douglas C Cheung; Lisa J Martin; Shabbir M H Alibhai; Maria Komisarenko; Christoffer Dharma; Yue Niu; Padraig Warde; Srikala S Sridhar; Neil E Fleshner; Girish S Kulkarni; Antonio Finelli Journal: Can Urol Assoc J Date: 2022-10 Impact factor: 2.052