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Old 11-15-2010, 01:17 PM   #1
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Which is better ~ Lupron or Firmagon

My husband has advanced prostate cancer. He is due for his second Firmagon injection tomorrow (Tuesday 11/16). This is the only treatment he will receive for his PCa at this time, because he will first be having chemotherapy for Hodgkin's lymphoma starting the Friday after Thanksgiving.

My questions are:
1) Is there an advantage (physically) to having treatment every three months (Lupron) vs every 28 days (Firmagon).... side effects- tired, night sweats, foggy etc.

2) Is there a monetary advantage? Firmagon will cost us $90 each visit after insurance.

3) Is one more successful than the other?

Any help, suggestions, advice... appreciated.
~ Joyce

John is 79 yrs, Stage 4, gleason (4 +5) 9. Bone scan ok

 
Old 11-17-2010, 06:26 PM   #2
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Re: Which is better ~ Lupron or Firmagon

Hi Joyce,

Sorry for the Lymphoma condition of your husband. I just started hormonal treatment so cannot answer your question in detail. However, I have been reading a lot about the drugs used in HT and what I can say is that both drugs are good. Lupron is an LHRH agonist while Degarelix is a (newer drug) called an antagonist. Both aim at blocking the testosterone from getting into the cancer cells, by stopping its production or block the GnRH receptor. The side effects are similar but some patients do better with Degarelix thought, experiencing pain for 3-5 days at the place where the injections are given. Degarelix does not cause tumor flare as Lupron at their application. Many people on Lupron experienced terrible exhaustion and mood swings.

One point to consider is that Degarelix is given every 28 days while Lupron can be given either, monthly, every 4-month or every 6-month shots so that means less painful injections. I am on a 6-month shot.

Hope that you get answers from other guys in the forum with experience on both.

Wishing you the best.
Baptista

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Old 11-18-2010, 02:28 AM   #3
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Re: Which is better ~ Lupron or Firmagon

Baptista,
Thanks for your reply. Hope you are doing well yourself.

Yes, I have done similar research and am familiar with all the pros and cons of flare up and side effects. I just hoped to learn if one did a better job at reducing the testosterone and/or was effective longer.

John (my husband) had his second treatment of Firmagon on Tuesday the 16th. In discussing with his Urologist they have decided to swith to Lupron next visit. I hope it is the right choice. ~ Joyce

 
Old 11-18-2010, 03:49 AM   #4
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Re: Which is better ~ Lupron or Firmagon

Joyce
< edited >

Looking into the comments from many guys on drugs (HT), the most exposed problem of Firmagon is its painful injections to which your husband has been exposed. Other side effects seem to be equal.
The effectiveness of the drugs in their own fields targets the same principal of getting us to castration levels, and they have proved to be equal good on that too. Firmagon (Degarelix) is a drug with two years approval so that it has no long time data on its use (but it has been on a two years (???) trials proving its qualities). In regards to Lupron, I read about guys having it for ten years and doing well. A good thing is that we can move from one to the other without worrying too much. Many guys that have found Lupron not suitable, changed back to Firmagon, and vice versa, or added other drugs to the “cocktail”.

Your husband’s doctor may well have chosen Lupron due to the wider choice in the periods of application so that he can better plan a strategic treatment thinking in the Hodgkin's lymphoma problem. Only time will tell if that is the best choice in your husband’s case. My doctor wants to test me on Eligard (Lupron) for six-months as a mono-blocker. If it doesn’t work he will put me on another drug, probably Firmagon.
Firmagon injections are expensive in the USA (2,000$) so that you have to ascertain of its coverage by your insurance for a long period of time.

Wishing you both the best.
Baptista

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Old 11-18-2010, 05:48 AM   #5
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Re: Which is better ~ Lupron or Firmagon

Hi Joyce,

I'm responding to your post #3, and have read the responses to date. Baptista has covered the key information as I know it. I'm thinking he has seen patients with exhaustion and mood swings and is therefore believing that many are subject to those, but the research suggests that most of us do not experience them on hormonal blockade, probably of whatever type that sharply reduces testosterone.

Your cost for the Firmagon is really low. My Lupron co-pay often approaches $200. Another alternative is Zoladex, which involves putting a very small coil in a stomach muscle - not considered a big deal by patients. Zoladex should be available as a generic soon as its patent protection expires this year.

With a Gleason 9, Stage 4 cancer, your husband would be put on an antiandrogen (such as generic bicalutamide) and a 5-alpha reductase inhibitor (Avodart or generic finasteride) by the doctors I follow who are experts. I doubt that would interfere with his chemotherapy, but I've had no enrolled medical education. The doctors I follow would also likely have him on a powerful bisphosphonate, such as Zometa, but I'm not aware how that would relate to chemotherapy.

Take care and good luck,

Jim


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Originally Posted by PAgrandma View Post
Baptista,
Thanks for your reply. Hope you are doing well yourself.

Yes, I have done similar research and am familiar with all the pros and cons of flare up and side effects. I just hoped to learn if one did a better job at reducing the testosterone and/or was effective longer.

John (my husband) had his second treatment of Firmagon on Tuesday the 16th. In discussing with his Urologist they have decided to swith to Lupron next visit. I hope it is the right choice. ~ Joyce

 
Old 11-18-2010, 12:57 PM   #6
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Re: Which is better ~ Lupron or Firmagon

Jim, Thanks for your information about possible additional treatment.
I have made multiple notes, read about each on the internet and will question John's doctors. Yes, there are three.

The Urologist did the prostate biopsy diagnosis and handles current hormone treatments.

Oncologist #1 was referred by Urologist. He will treat prostate later with cone beam imaging after Hodgkins under control.

Oncologist #2 was referred by #1. He will handle chemo for Hodgkins which will begin Friday after Thanksgiving.

I don't know who... but SOMEONE will give me an answer about your suggested options.

~ Joyce
p.s. Firmagon @ $90 a month = $270... You're still ahead of the game with Lupron at $200 every three. BTW, we still haven't received a bill...so don't know for sure.

 
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Old 02-07-2011, 12:13 PM   #7
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Re: Which is better ~ Lupron or Firmagon

Regarding Lupron and Firmagon (degalerix), my husband was on Lupron for 3 years (on and off) and his PSA was rising so we decided to try something else. I like that firmagon works by blocking action rather than prompting the pituitary to overproduce GnRH to the point that it shuts down. It is this excessive production that produces the flare effect. He had his first Firmagon in January and I am anxious to see what effect it has on the testosterone and PSA. Aside from the temporary pain from the injection, there seems to be no difference in side effects. The hot flashes continue and of course the libido is gone. 2357HB

 
Old 02-08-2011, 01:50 AM   #8
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Re: Which is better ~ Lupron or Firmagon

I appreciate hearing from you and learning about the challenge that we are facing.

My husband will receive his second Lupron injection in April. We were not given information about his PSA readings when changing from Firmagon to Lupron in December so I can't compare the effectiveness of the two treatments.

Because he is also receiving chemotherapy every fourteen days for his Hodgkin's lymphoma it is not possible to determine which medication is causing which side effect.

I hope your husband has good results! ~ Joyce

 
Old 02-08-2011, 03:11 PM   #9
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Re: Which is better ~ Lupron or Firmagon

Hi 2357HB,

Welcome to the board. I wish success to your husband in the control of the cancer with Firmagon. I read about patients that change drugs and start feeling better or experience a better result (lower PSA). For confirmation of drugs effectiveness I would suggest your husband to have a testosterone test taken together with the PSA.
Please, let us know about his progress. Many here including me, may one day need to change drugs and it would be good to know about experiences in the two drugs effectiveness.

Both drugs, Lupron and Firmagon have the same purposes in the treatment of PCa, which is to cause stoppage in the production of testosterone at the testis. Both are successful. The difference is that Lupron is an GnRH agonist which will increase the release of the luteinising hormone (LH) and follicle-stimulating hormone (FSH) for testosterone production (the flare effect) until the body stops it due to “congestion” (process of downregulation); and Firmagon is a GnRh antagonist that will block the GnRH receptors in the pituitary gland, therefore blocking directly the receptors stopping the release of the hormones sooner.

Some studies have indicated ineffective testosterone suppression in patients on LHRH agonist treatment but it is not clear if that surge in testosterone originate from breakthroughs in testis production, or if that is due to adrenal gland production and intratumoral production.

I wish continuous improvement in the prognosis of your husband case and that of Joyce’s husband.
Baptista

 
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