The evidence supporting this regimen comes from a review by Loblaw et al. The initial review consisted of 10 randomised controlled trials, six systemic reviews and one Marko model to formulate the guidelines. Bilateral orchidectomy or luteinising hormone releasing hormone agonists (LHRH) are the recommended initial treatments.r An update of these guidelines were published in 2007 with no change in the above standard first-line treatments.r
A meta-analysis of the literature (10 RCTs, 1,908 patients) addressed the relative benefit of LHRH agonists with orchidectomy, diethylstibestrol (DES), or the choice of DES or orchidectomy. No improvement in survival rate, time to progression of disease, or time to treatment failure was observed (which included drug discontinuations indicative of adverse events in the medically managed patients). Two-year hazard ratio for OS was 1.26 (95% CI, 0.91 to 1.39) compared to orchidectomy.r
Efficacy
Meta-analysis of the literature reporting survival at 2 years for different androgen deprivation therapiesr
DES: diethylstibestrol
© Annals of Internal Medicine 2000
Toxicity
Toxicityr |
Eligard 7.5 mg
(%) |
Eligard 22.5 mg
(%) |
Eligard 30 mg
(%) |
Eligard 45 mg |
Malaise and fatigue |
17.5 |
6.0 |
13.3 |
15.3 |
Hot flushes, sweats |
56.7 |
56.4 |
73.3 |
57.7 |
Urinary frequency |
No data |
2.6 |
2.2 |
No data |
Musculoskeletal (arthralgia, joint disorders and myalgia) |
No data |
3.4 |
2.2 |
7.2 |