Dr. Cone on Cardiac Toxicity With GnRH Agonists in Prostate Cancer

Eugene B. Cone, MD, urologist, Massachusetts General Hospital, discusses the cardiac toxicity associated with gonadotropin-releasing hormone (GnRH) agonists in prostate cancer.

GnRH agonists and antagonists are used in the treatment of patients with advanced prostate cancer; however, the relative risk of cardiac toxicity is not well defined, says Cone. Using VigiBase, the World Health Organization’s global database of case safety reports, investigators identified cardiac-related adverse events that were associated with the GnRH antagonist degarelix (Firmagon) and the GnRH agonists, leuprolide, goserelin, triptorelin, and histrelin.

The analysis showed that GnRH agonists have a significantly worse risk of cardiac toxicity compared with GnRH antagonists. These data suggest that a patient with biochemical recurrence who has had a heart attack should receive a GnRH antagonist opposed to a GnRH agonist, says Cone. Although the data are less clear regarding men with other comorbidities, GnRH antagonists are believed to be the preferred drug class, concludes Cone.