Sometimes it takes a while for a drug manufacturer to ramp up production and get it into wide distribution. Myovant is predicting Orgovyx (relugolix) will be available next month, according to their website. An internet site says Orgovyx carries a list price of $2,313 per bottle containing 30 pills (ouch!). No info on which drug plans will cover it, but there is a cost-assistance program, and there is a 2-month free trial.
Thanks, TA. Do you think it will have the same efficacy as Firmagon? I am doing well on Firmogon but hate the side effect of the injection site. It lasts at least 10 days for me while being in pain.
My concerns: 1) Lupron has been around for years. We know the short term and long term side effects. This is a new drug. Clinical trial, yes, but for how long? Do we really know long term effects, especially cardiac related. 2) Financial. For us Medicare guys Lupron is a shot-paid for by Part B. Pills are a Part D, part of the drug plan. Specialty meds have large copays. My Abiraterone is already expensive. I don't need another. 3) If your PSA is <0.01 taking Lupron and Abiraterone, do you want to mess with success and change drugs?
Good points! You are right - the HERO RCT of relugolix only had 48 weeks of follow-up - we have no idea about side effects that may be cumulative over time. Interactions with other drugs (like abiraterone or enzalutamide) have not been tested. Nor do we know much about its castration-resistance natural history. I agree about the financial toxicity too.
I think the big advantages of Orgovyx are that it starts working immediately and that testosterone returns quickly afterwards. That means it may be particularly useful in certain situations:
• for men newly diagnosed with metastases who are concerned that the initial testosterone boost from a GnRH agonist (like Lupron or Eligard) might aggravate symptoms. It replaces temporary early Casodex or Firmagon, and can be followed with a GnRH agonist injection.
• for men using ADT as an adjuvant therapy to radiation - quicker lead-in period and quicker testosterone return afterwards.
• for men on intermittent ADT (or BAT) - quicker start of the "on" cycle and quicker QOL return at the start of the vacation.
I read an article yesterday that it bettered Lupron in maintaining castration but was about equal in preventing castration resistance. I didn't quite get the distinction. If that rings a bell, can you explain? If not, I'll try to clarify later. Thanks.
Both drugs cause chemical castration - negligible testosterone. Castration prevents the androgen receptor on prostate cancer cells from getting activated. Eventually, the androgen receptor becomes resistant to castration - it gets activated in spite of negligible testosterone.
Do you think they can negatively affect the gut microbiome or reduce the effectiveness of other supplements, vitamins or food nutrition since they are going into your belly with the other stuff? Gut microbiome is essential to immunity and general health, not to mention abdominal comfort of lack there of.
Thanks for posting this. Some major cancer centers and my urologist have no Lupron available due to a nationwide shortage; only Eligard was available to me last week. This will give doctors another tool in their toolkit.
I spoke to the manufacturer of Orgovyx this morning. I also spoke to Optum Rx, my speciality drug supplier through my Medicare supplement, Blue Cross PPO. Orgovyx is the brand name for relugolix.
The manufacturer said the drug will become available on a limited basis to limited pharmacies sometime in January. There is a website that the oncologist will need to go to to get further information about availability and where to send the prescriptions. Each drug plan has its own formulary so the manufacturer could not quote cost.
Optum RX has relugolix listed in their formulary for my drug plan as a tier 3 drug. My copay would be $50 for a 30-day Supply, $150 for a 90 day supply.
As TA mentioned this drug has the potential to cause some cardiac arrhythmias. But if you look at the side effect profile of the other ADT drugs they have the same potential. The studies to date indicated a 54% reduction of cardiac toxicity with this drug vs Lupron.
I do not get the heart impact during hot flashes, while taking the orgovyx, like I did with Lupron. However, I get other side effects with this orgovyx, which I did not get with Lupron. I just posted a question on this site about this topic. Let's see if anyone replies.
Hi Allen, that's great news to the advanced survivors. Hopefully, the oral type is as effective as the ADT shots. I don't know when it will get to Taiwan. I guess the urologists or oncologists in Taiwan have never heard of this oral drug.
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