The relative cardiovascular safety of gonadotropin-releasing hormone (GnRH) antagonists compared with GnRH agonists in men with prostate cancer remains unresolved after findings from the PRONOUNCE trial presented at ESC Congress 2021 and simultaneously published in Circulation. The trial found no difference in major adverse cardiovascular events (MACE) at one year in patients assigned to degarelix compared with leuprolide.

The international, multicenter, prospective, open-label trial randomized 545 men (planned enrollment was 900) with prostate cancer and concomitant ASCVD to either the GnRH antagonist degarelix or the GnRH agonist leuprolide for 12 months. The median age of study participants was 73 years and nearly 50% had localized prostate cancer, while 26.3% had locally advanced disease and 20.4% had metastatic disease. The primary outcome was time to first occurrence of MACE through 12 months.

Overall, MACE occurred in 5.5% of patients in the degarelix group (n=15) compared with 4.1% in the leuprolide group (n=11), but the trial was terminated early due to slow enrollment and a smaller than planned number of events.

Despite the results, principal investigator Renato D. Lopes, MD, PhD, FACC, said there remains an "ongoing need to understand the cardiovascular effects of oncological treatments as cancer survivorship increases and competing non-cancer death becomes more likely." He added that one positive outcome of the trial, is that it can be used as a model "for the interdisciplinary collaboration between oncologists and cardiologists with a shared goal of evaluating the impact of cancer therapies on cardiovascular outcomes."

Clinical Topics: Cardio-Oncology, Cardiovascular Care Team

Keywords: ESC Congress, ESC21, Neoplasms, ACC International, Cardiotoxicity

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