A Practical Guide to Relugolix: Early Experience with Oral ADT

A Practical Guide to Relugolix: Early Experience With Oral Androgen Deprivation Therapy (2023, Full Text)

"Abstract

Background
Relugolix is the newest form of androgen deprivation therapy (ADT) approved for prostate cancer. However, as an oral drug, several real-world concerns exist, particularly medication compliance, safety with other androgen receptor-targeted agents, and financial burden to patients.

Methods
A single institution retrospective chart review was conducted evaluating all patients who were prescribed relugolix for any prostate cancer indication from January 1, 2021 to January 31, 2022. Demographic data, cardiac risk factors, concomitant therapy usage, and PSA/testosterone levels, were abstracted from the chart review. Adverse effects were obtained by examining progress notes. Compliance was assessed by clinic notes as well as prescription fills by specialty pharmacy records. The reasons patients did not fill or discontinued the medication were noted.

Results
Hundred and one patients were prescribed relugolix, and 91 patients consented to research. Seventy-one (78%) patients filled the prescription to relugolix, with a median follow-up of 5 months. Prescription fill data were available for 45 (63%) patients, with 94% of days covered. The most commonly reported reason not to fill was cost at 50%. Sixty-six (93%) patients reported never missing a dose. PSA levels were available in 71 (100%) patients with 69 (97%) showing stable or improved PSA. Testosterone levels were available in 61 (86%) of patients, which showed 61 (100%) stable or successful castration. Twenty-four (34%) patients used relugolix in combination. No new major safety signals were seen in combination therapy. Nineteen (27%) patients had switched to another form of ADT. Fifteen of these (79%) felt similar or better on relugolix therapy.

Conclusions
Compliance with relugolix seemed acceptable. No major new safety signals were seen, even in combination. Among patients who switched therapy, most tolerated relugolix similarly or better than the previous form of ADT. The cost was a major reason for patients not initiating and for discontinuing therapy.

Implications for Practice

Relugolix is the newest form of androgen deprivation therapy approved for prostate cancer. From a high-volume center and early adopters of relugolix therapy, the authors share their experience with this novel drug, including some of the issues encountered with it. This retrospective study highlights practical and real-world issues encountered with relugolix. Concerns of compliance, data on combination therapy, and transitioning from either leuprolide or degarelix to relugolix are addressed."

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Djin

I think the results on efficacy, stable PSA, high-level testosterone suppression (the goal of all forms of ADT), and patient compliance (taking the ADT medication daily) all seemed very favorable in this report.

It's the newest form of ADT, and it's important to receive feedback on new options.

Due to the discovery that my initial form of ADT (in the form of injections) didn't fully suppress my testosterone levels, leading to very worrisome "spikes and flares" in my PSA levels, my oncologist led me from LUPRON to FIRMAGON and ultimately to ZOLADEX injections.

I think it's important to remember ~ no matter WHICH form of ADT you are on ~ to ask your doctor to assess the testosterone levels when you are monitoring PSA.

If your testosterone level isn't being fully suppressed, you may need to try another form of ADT.

I did find it wasn't an issue, trying the various forms of ADT. For my case, it became imperative. ZOLODEX, for my case, worked the best ~ and has worked well for me for years now.

My oncologist and I have not discussed RELUGOLIX --- this newer ADT medication. My mind is open, but I feel ZOLADEX is working well for me.

In the posted report, a primary concern was the higher cost of RELUGOLIX.

With more ADT options, I would think that might drive down the cost of some forms of ADT, to leverage greater competition, in terms of pricing.

CYCLONE ~ # Iowa State University