Orgovyx + Abiaterone?

[Hope49823]

I have very high risk prostate cancer (Gleason 9, negative PSMA for spread, MRI suggests possible spread to seminal vessel, PSA in 7s before treatment).

Due to cardiac history (stroke and heart attack) MO is being cautious and has started dosing Eligard at 1 Month intervals to make sure I am doing ok instead of doing 3 or 6 month injections. (On Casodex to avoid initial T flare.) Wants to make sure doing ok on this ADT and then add Abiaterone. RT in 2 months.

MO said that Orgovyx + Abiaterone is not an option by NCCN guidelines, could be interaction issues (paraphrasing). But I see several posts of others taking this combo instead of Eligard/Lupron. Orgovyx seemed to have a better cardiac profile. Any insight?

Thanks.

[JohnInTheMiddle]

What interactions? I'm on Abiraterone plus Firmagon/Degarelix which is injected of course but it is also GnRH antagonist like Orgovyx. I have not heard of any interactions. There are side effects from any drugs - I've avoided most of them. I can't speak for Orgovyx - I would be very happy to take that. Do some more homework. What does your MO know concretely?

[Hope49823 in reply to JohnInTheMiddle]

This was in the MO notes: -As per NCCN guidelines: "Relugolix has not been adequately studied in combination with potent androgen receptor inhibitors such as enzalutamide, apalutamide, darolutamide, or abiraterone acetate, nor has it been studied in combination with docetaxel or cabazitaxel chemotherapy. Potential drug interactions include induction of cytochrome P450 enzymes and reduced concentration and efficacy of relugolix with enzalutamide or apalutamide and cardiac QTc interactions with abiraterone.

Further studies of relugolix dosing and drug interactions with commonly used agents in advanced prostate cancer are needed to ensure patient safety and proper dosing."

[JohnInTheMiddle in reply to Hope49823]

OK interesting. Long Qt is a thing. Looks like your MO knows what he or she talking about! 😃 So will both have to wait a couple years then? I have been kind of enthusiastic about the thing but I don't have to worry yet because it's not approved under my Canadian health insurance yet. In the meantime I'm happy to stick with Firmagon once a month.

By the way if you think it's worth pursuing I note an error in the comment - Abiraterone is not an AR inhibitor like all the lutamides - it's an ARPI or "androgen receptor pathway inhibitor" and works in a completely different way by suppressing the CYP17 enzyme for testosterone synthesis. Maybe this suggests that the comment is not up to date?

[Hope49823 in reply to JohnInTheMiddle]

I’m not up to speed enough about that. Maybe it is poor wording that Abiaterone potential QTc interactions and not the reduced efficacy?

Ideal plan is to be on Eligard + Abiaterone for 18months - 3years.

[JohnInTheMiddle in reply to Hope49823]

I know that there are no metastases! That's fantastic!

[Desertdad in reply to Hope49823]

I was diagnosed in July 2023 with advanced pc. Metastasis in hip and leg bones. Psa was 85.4 My urologist started me on Orgovyx and Zytiga plus prednisone. After 1 month I did my first blood tests and my psa had dropped to 0.8 and testosterone was at 3. No side effects but Dr. noticed the blood panel showed my liver enzymes to be elevated above normal range. Continue to take the medication and check again in another month. Second blood test showed psa at 0.3 and t at 3. Liver enzymes were very high levels. Alt was 889 and ast was 333. Dr told me to stop taking the abi (Zytiga) and prednisone but continue with Orgovyx. One check up again and psa is 0.2 and t is 3. Liver enzymes dropped 200 points. Now alt was 680 and ast was 179. Dr. said stay on this course until liver recovery is complete to normal levels the we will discuss next options.

[timotur]

Be careful with Abi, it will lengthen your Q-T interval and result in ventricular tachycardia along with high BP. On Abi for six months, my BP went from about 110/70 to 160/98. You may start with a lower dose and go from there.

This 61yo wound up in ER, nearly died...

cureus.com/articles/74434-a...

[Hope49823 in reply to timotur]

Thank you very much

[jfoesq in reply to timotur]

Timotur- I am sorry to hear about your terrible reaction to Abi, but I think you may have overstated the negative responses one has to it by saying "It will...." I have been on Abi for most of my 11+ years of treatment and only recently has my BP gone up (I just started taking a low dose of valsartan 2 weeks ago, which has brought my BP back to normal without any side-effects that I am aware of, except for a minor headache when awakening in the morning for the first 10 days). I just had labs and an EKG done for pre-surgical testing and while I don't know what Q-T is I am unaware of any other health issues Abi has caused ME.

Glad you recovered from your response and I hope you are doing well now.

[dhccpa in reply to timotur]

In the past, I thought TA had commented that that's generally a dosage issue with the prednisone--get the dose right and solves the issue (generally). But doublecheck me with TA.

[Tall_Allen]

Show your MO these:

"Among all the patients, the incidence of major adverse cardiovascular events was 2.9% in the relugolix group and 6.2% in the leuprolide group (hazard ratio, 0.46; 95% CI, 0.24 to 0.88)... In the subgroup of patients with a reported medical history of these events, the incidence of major adverse cardiovascular events during receipt of the trial drug was 3.6% (3 of 84 patients) in the relugolix group and 17.8% (8 of 45 patients) in the leuprolide group, which indicates that the odds of having an event were 4.8 times as high with leuprolide as with relugolix "

nejm.org/doi/full/10.1056/N...

These might explain why:

ncbi.nlm.nih.gov/pmc/articl...

auajournals.org/doi/abs/10....

urotoday.com/conference-hig...

[Hope49823 in reply to Tall_Allen]

Thank you Tall Allen will do. Do you know of any issues of switching from Eligard to Orgovyx since I have Eligard on board (currently in middle of 1 month dose)? Would it be worrisome to take Orgovyx with Abiaterone? MO and RT had notes also about Orgovyx not being as well studied with very high risk cancer.

[Tall_Allen in reply to Hope49823]

I know of no issues in switching - patients usually switch from Degarelix to Lupron for convenience of the multi-month shot.

They are right that Orgovyx has not been tested with abiraterone, but the same could be said about Firmagon. I can't think of any reason why all GnRH agonists and antagonists shouldn't be equally effective, since they do the same thing - shut down all endogenous production of testosterone by the testes.

The only misgiving I have about Orgovyx is compliance - the half-life is only 24 hours so it is critical to not miss any doses.

[Hope49823 in reply to Tall_Allen]

Thanks much as always. Yes compliance on the pills definitely could be a factor for some.

[jfoesq in reply to Tall_Allen]

Tall Allen- I am having hip replacement surgery on February 7. My MO has recommended I stop taking Aberaterone 5 days beforehand to avoid any contraindications with meds/ anesthesia I will be receiving. I don’t have to go off the Abi for my TKR 6 yrs ago. My pSA has been rising slowly this past year from below .05, .05,.06,.06,.09 so I would like to avoid going off of it even for 5 days Do you have any thoughts on this?

Thx

[Tall_Allen in reply to jfoesq]

Your liver will have to process the anesthesia. You are taking a gamble in forcing it to detoxify both.

[JohnInTheMiddle in reply to Tall_Allen]

This is important information that I just learned - that if one has to have surgery with anaesthesia then one has to likely go off Abiraterone for a week! Maybe this should be a separate post - what are the options and the risks?

[jfoesq in reply to Tall_Allen]

Thx, TA. In light of your response, I will follow my MO's advice and discontinue my Abi for the 5 days before surgery.

[JohnInTheMiddle in reply to Tall_Allen]

Wow thanks for sharing Tall Alan! Great information about Relugolix/Orgovyx!

[CancerConcierge]

My husband met requirements per the Stampede trial to use abiraterone/prednisone with ADT( he chose Orgovyx) Gleason 9 with PSA 46.6, PCA localized. He is being treated at Mayo in Phoenix....his RO recommended he consider adding the abiraterone, referred to MO.

[Hope49823 in reply to CancerConcierge]

Thank you for sharing this, wish him the best for treatment success.

[CancerConcierge in reply to Hope49823]

Thanks! We are optimistic!

[Anthonyve]

that sounds very exciting.. Thanks for posting. 😊

[Wombat88]

I've been on Abiraterone & Orgovyx & Prednisone for about a year. Switched from Firmagon to Orgovyx one year ago. Neurological side effects seem less with Orgovyx. I have mets but things have been quiet for a couple of years. I have a heart arrhythmia managed with blood thinner and calcium channel blocker. So far so good. I'm working with a local Norcal oncologist and checking in with UCSF. And hey, thanks Tall Allen.

[Vynbal]

I did not have high risk PCa, so no Abi but I was treated in 6/2021 when Orgovyx was quite new. I have a heart rhythm disorder (Brugada syndrome) and was concerned about ADT lengthening my QT. But my MO was quite reluctant to try something new. He knew nothing about heart rhythms and my EP knew nothing about ADT. After they consulted I was green lit for O but EP had me come in for weekly EKGs for a month to check my progress. I saw my QT steadily lengthen, but then plateau at a still safe level. The short half life was a good selling point, as it meant an adverse effect could be quickly reversed.

[Hope49823 in reply to Vynbal]

Thank you for sharing your experience, glad Orgovyx has been a safe option for you. My MO has suggested monitoring EKG monthly and Echo quarterly so far.

[daleboy3]

Hello I have read your information & have noticed you are at cardiac risk, nearly all forms of treatment for prostate cause damage to the immune system so I bought Black Fermented Garlic capsules which grows in eastern countries & Africa this particular Garlic fights cancer cells & builds up your immune system as they have 12 times the amount of Acillin the active compound in garlic do some research first ok. I bought the Dr Mercola capsules from Amazon a high grade source

[85745 in reply to daleboy3]

A week ago p/u the same Dr Mercola garlic from amazon, I like it, I do a few post on natural supps, not much of a positive responce back most times. lol. Fermented foods are also good for the gut biome and vit rich. Thanks

[daleboy3 in reply to 85745]

yes I also used the black Fermented garlic after getting Covid I bounced back to health in 5 days where as my wife Struggled big time she was put on Steroids & Antibiotics for a week that left her weak so I got her to take the Fermented Garlic & Seven days later she got up & went Short Mat Bowling as if she had never had Covid, so this just proved beyond a shadow of doubt it boosts the Immune system & restores gut health & ENEGY ✔️👍

[Explorer08]

I am taking Orgovyx now and will soon add in Xtandi after my radiation treatment for gynecomastia in a couple of weeks. Harvard Medical put out an article just a few weeks ago about how going on Xtandi earlier in the game was very effective for those that are still hormone sensitive like me. My MO gave me a choice between Zytiga with prednisone or Xtandi - - I chose Xtandi so I could avoid the prednisone and its side effects. The Harvard article did point out that Xtandi has gynecomastia as a common side effect, hence my doing the radiation to head that off at the pass. (This week my PSA is 0.09 and T is <7.0. I am oligometastatic with one pelvic lymph node lighting up on the PSMA PET scan.)

[Regulator]

I used abiraterone/prednisone + orgovyx for a bit over a year. I switched from Lupron to the orgovyx because of the possibility of reduced cardiovascular effects (evidenced in at least one of the clinical trials). Don't know of any drug interactions.

[joeguy]

I have been on Orgovyx/Nubeqa for a few years, and have found the combination to have very tolerable side effects. Sadly it is no longer working, so I am looking to switch to the one hormonal I have yet to try (Zytiga). I am a little apprehensive about the possible side effects of Zytiga because of the possible cardiac issues and issues that Prednisone can bring on, but Im running out of drugs to try, soooooooo....

[Hope49823 in reply to joeguy]

I hope it will work well for you.