臨床泌尿器科69巻5号

2015年04月発行

特集 前立腺癌の内分泌療法—気になる最新の動向

LH-RHアゴニストとLH-RHアンタゴニスト

著者： 計屋知彰¹ 酒井英樹¹

所属機関： ¹長崎大学大学院医歯薬学総合研究科泌尿器科学

ページ範囲：P.334 - P.338

要旨　アンドロゲン除去療法には従来LH-RHアゴニストが使用されてきたが，2012年にわが国でもLH-RHアンタゴニストであるデガレリクスが承認され，新たな治療選択肢が加わった。LH-RHアゴニストとLH-RHアンタゴニスト，この両者にどのような相違点があるかを理解することは，臨床の現場で患者に適切な治療を提供するうえで重要と思われる。本稿では改めてその開発における背景を概説する。また近年デガレリクスに関する新たな知見が加わりつつあるので，特にPSA無再発生存率，全生存率，心血管イベントおよび下部尿路症状に関する最新の情報を紹介する。

参考文献

1）矢野　哲，武谷雄二：GnRH analog療法．産科と婦人科39：1019-1026，1998

2）Thompson IM, Zeidman EJ and Rodrigez FR：Sudden death due to disease flare with luteinizing hormone releasing hormone agonist therapy for carcinoma of the prostate. J Urol 140：1479-1480, 1990

3）Tombal B, Miller K, Boccon-Gibod L, et al：Additional analysis of the secondary end point of biochemical recurrence rate in a phase 3 trial（CS21）comparing degarelix 80mg versus leuprolide in prostate cancer patients segmented by baseline characteristics. Eur Urol 57：836-842, 2010

4）Klotz L, Miller K, Crawford DE, et al：Disease control outcomes from analysis of pooled individual patient data from five comparative randomized clinical trials of degarelix versus luteinizing horumone-releasing hormone agonists. Eur Urol 66：1101-1108, 2014

5）Morote J, Morin JP, Orsola A, et al：Prevalence of osteoporosis during long-term androgen deprivation therapy in patients with prostate cancer. Urology 69：500-504, 2007

6）Klotz L, O'Callaghan C, Goldenberg L, et al：Nadir testosterone on ADT predicts for time to castrate resistant progression：a secondary analysis of the PR-7 intermittent vs. continuous ADT trial. Can Urol Assoc J 7：S37, 2013

7）Halmos G, Arencibia JM, Schally AV, et al：High incidence of receptors for luteinizing hormone-releasing hormone（LHRH）and LHRH receptor gene expression in human prostate cancers. J Urol 163：623-629, 2000

8）Radu A, Pichon C, Camparo P, et al：Expression of follicle-stimulating hormone receptor in tumor blood vessels. N Engl J Med 363：1621-1630, 2010

9）Albertsen PC, Klotz L, Tombal B, et al：Cardiovascular morbidity associated with gonadotropin releasing hormone agonists and an antagonist. Eur Urol 65：565-573, 2014

10）Hopmans SN, Duivenvoorden WCM, Werstuck GH, et al：GnRH antagonist associates with less adiposity and reduced characteristics of metabolic syndrome and atherosclerosis compared with orchiectomy and GnRH agonist in a preclinical mouse model. Urol Oncol 32：1126-1134, 2014

11）D'Amico AV, Chen MH, Renshaw AA, et al：Androgen suppression and radiation vs radiation alone for prostate cancer：a randomized trial. JAMA 299：289-295, 2008

12）Saigal CS, Gore JL, Krupski TL, et al：Androgen deprivation therapy increases cardiovascular morbidity in men with prostate cancer. Cancer 110：1493-1500, 2007

13）Mason M, Pijoan XM, Steidle C, et al：Neoadjuvant androgen deprivation therapy for prostate volume reduction, lower urinary tract symptom relief and quality of life improvement in men with intermediate- to high-risk prostate cancer：A randomized non-inferiority trial of degarelix versus goserelin plus bicalutamide. Clin Oncol 25：190-196, 2013

14）Axcrona K, Aaltomaa S, Martins C, et al：Androgen deprivation therapy for volume reduction, lower urinary symptom relief and quality of life improvement in patients with prostate cancer：degarelix vs goserelin plus bicalutamide. BJU Int 110：1721-1728, 2012