‘Stops and starts’ – an acceptable method of administering hormone therapy in prostate cancer?

The authors aimed to determine the effect of degarelix in treating prostate cancer. 

Hormone therapy is a prostate cancer treatment that targets the male sex hormones active in prostate cancer, such as testosterone. Degarelix (Firmagon) is a drug used in hormone therapy that reduces the levels of testosterone to slow or stop the spread of prostate cancer. Administering hormone therapy intermittently ('stops and starts') is increasingly being evaluated for benefit, as allowing patients a break from hormonal therapy may allow for a better quality of life. 

The aim of this study was to determine the effect of degarelix in treating prostate cancer when administered intermittently.

220 patients were used in this study. Treatment was given in two cycles – cycle 1 (19.4 months of treatment followed by an off-treatment period [patients did not receive degarelix]) and cycle 2 (14.7 months of treatment followed by an off-treatment period).

In cycle 1 the average time to prostate specific antigen (PSA – protein elevated in the blood in the presence of prostate cancer) progression of more than 4ng/ml was 392 days. 48 patients had PSA levels that remained below 4ng/ml during cycle 1. In cycle 2 the average time to PSA progression of more than 4ng/ml was 224 days.

99% of patients experienced significantly reduced testosterone levels of less than 0.5ng/ml. In cycle 1 the average time from treatment until testosterone levels increased higher than 0.5ng/ml was 112 days and 168 days until levels increased higher than 2.2ng/ml. Results were similar in cycle 2.

No major side-effects were experienced during treatment, however some patients experienced decreased sexual functioning during the induction period which improved during off-treatment periods.

The authors concluded that intermittent administration of degarelix was a safe and effective treatment for prostate cancer that lowered PSA levels.

Further studies are required for results to be widely applied.

If you are considering hormone therapy as a treatment option, please talk to your doctor about potential benefits associated with intermittent hormonal therapy.