Eligard v Orgovyx

[Vman1]

Hi all. I’ve been on Eligard for 4 months (had 6 month injection in October 2024). Side effects have been very minimal (minor intermittent hot flashes and some fatigue). I am Gleason 7 (4+3) with spread to local lymph nodes. Had radiation and planning on 2 years Eligard and abi + prednisone as per doctor ‘s plan. I’m thinking of asking to switch to Orgovyx due to its better safety profile and wondering if anyone has done that? Is that a good idea? Are there problems with making that switch and can Orgovyx be taken with Zytiga and prednisone? I highly value this forum and appreciate your comments.

[petrig]

In my knowledge there are no problems when taking Orgovyx with Zytiga. Orgovyx is actually better and safer adt than Eligard.IAfter 19 monthly Firmagon injections I am switching to Orgovyx in February. I do take Nubeqa(darolutamide) but not Zytiga.

"Combination therapy of relugolix and abiraterone or apalutamide was associated with a favorable safety and tolerability profile consistent with the known profiles of the individual medications. Castration levels of testosterone were maintained after transitioning to relugolix from other ADTs".

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

[GP24 in reply to petrig]

Thank you for the link. In this article it is mentioned: " the recommended daily dose of relugolix was increased to 240 mg considering that apalutamide is a combined permeability glycoprotein (P-gp) and strong CYP3A inducer that causes relugolix concentrations to be reduced by approximately half." You should be aware of this when you combine Orgovyx with Apalutamide.

[Vman1 in reply to GP24]

Perfect. Thank you.

[petrig in reply to GP24]

Zytiga is abiraterone acetate not apalutamide.But good point if taking apalutamide.

[Vman1 in reply to petrig]

Thank you very much

[Aldo62]

I switched to Orgovyx from Lupron and found it much more tolerable.

[Vman1 in reply to Aldo62]

Thanks Aldo62. More tolerable how, if I may ask? How long were you on Lupron before you switched?

[IKNY in reply to Aldo62]

Aldo62, what was more tolerable about Orgovyx?

I’m on Lupron 3month injections and Nubeqa (Doralutamide).

I’ve been considering Orgovyx, I’ll bring the question up at my Feb6 MO meeting.

Thanks!

[Aldo62 in reply to IKNY]

I had a lot more muscle pain with Lupron and I generally felt worse. ED, loss of libido, fatigue, depression~ All much worse with Lupron. Orgovyx has a shorter lifespan, too, and washes out of the system more quickly if you ever want to take a vacation from ADT.

[IKNY in reply to Aldo62]

Thanks!

[vintage42]

"... Are there problems with making that switch and can Orgovyx be taken with Zytiga and prednisone?"

I don't know about the switch, but I have taken Orgovyx with Zytiga and prednisone for a year with no problems. The Uro had me on 10 mg of prednisone for the first 8 months which caused thin skin on arms, covered with purple bruise blotches, constant skin tears that took weeks to heal, afraid to even slide a hand into a tight jeans pocket. I envied people who were on 5 mg.

I then read an article here from Tall-Allen that said 10 mg is for castrate-resistant and 5 mg is for castrate-senstive, so I reduced myself to 7.5 and then 5, and told the Uro 2 months later when my skin was clear and my labs were good. prostatecancer.news/2019/06...

[Explorer08]

I’ve been on Orgovyx with Xtandi added in later. I chose Xtandi so I would not have to take prednisone with my other option, Zytiga. Full dose of Xtandi was too much when it came to side effects so I’m now taking a half dose each day. So far working well.

[BMRboy in reply to Explorer08]

Explorer08 - I am about ready to start the Orgovyx and Xtandi combo after a 15 month vacation from six months of Orgovyx only in 2023. While on Orgovyx I had fatigue, hot flashes and some depression as side effects. I power walked two miles almost every day to help with the fatigue, which was the most bothersome for me. What side effects were more intense for you while you were on the Orgovyx and full dose of Xtandi combination?

Thanks.

[Explorer08 in reply to BMRboy]

BMRboy: I was on Orgovyx for 55 weeks and it worked well. I then went on an ADT vacation for about a year and returned when my PSA rose from undetectable to 0.78 in late 2023. Based on a study of Xtandi in combination with Orgovyx (published by the Harvard medical newsletter) I added in Xtandi in February 2024. The combo, according to the article, showed that men who took these two together had a better outcome when still hormone sensitive. I had virtually no side effects from Orgovyx alone but adding Xtandi caused fatigue in the extreme, severe constipation, heavy duty brain fog, weakness, and rapid muscle loss. I kept going with Orgovyx but stopped Xtandi for three months and just restarted at half dose this January 2025. So far all is good - PSA and Testosterone undetectable. I'm still hormone sensitive. (RRP in 2011, SRT in 2013; one left iliac lymph node lights up on a PSMA PET scan which makes me oligometastatic.)

[BMRboy in reply to Explorer08]

Thank you for your reply Explorer08.

I am surprised your oncologist did not have the one left iliac lymph node radiated unless the radiation field it is in had already been radiated. I had SRT twice after my recurrence and before starting the Orgovyx in early 2023, my PSMA scan had several avid para aortic nodes light up which my radiation oncologist did not recommend they be radiated to avoid gastrointestinal side effects. According to him I was no longer oligometastatic. My PSA has been rising the last few months and at present is just below 1.0. I will have labs again tomorrow and I expect another PSMA scan next. If the nodes are still present I guess the best I can do is start the doublet therapy and see how I fare. I am really concerned about the intense side effects as I am still employed and I need to continue working.

Thanks again.

[Explorer08 in reply to BMRboy]

BMRboy: Since I'd already had SRT accompanied by radiation tissue damage they didn't want to irradiate just for one lymph node and surgery would have been problematic due to location. Further that lymph has measurably shrunk so it's wait and see more than anything else. Good luck to you!

[NecessarilySo]

I switched from Lupron to Eligard, (due to Lupron shortage), then to Orgovyx and then back to Lupron with no difference in side effects except that I discovered that I had high QT which made Orgovyx a bad choice.

[Vman1 in reply to NecessarilySo]

Good to hear. I assume you’ve had no cardiac side effects taking either Lupron or Eligard? How long have you been on these?

[petrig in reply to Vman1]

The risk of major adverse cardiovascular events was 54% lower with relugolix than with leuprolide.

[NecessarilySo in reply to Vman1]

Lupron intermittently since 2012, continuously for past five years, except for the changes mentioned a few years ago. Orgavyx warns about heart problems, mine are mild.

[MomOfMaisy]

My husband has been on daily Zytiga and Eligard injections every 3 months for over a year with absolutely no issues. Lack of libido (expected) is his primary “side effect”. He has regular lab work to check his levels; liver, etc. and so far, so good. His PSA has been undetectable for several months since after his last radiation treatment. I imagine unless his oncologist suggests otherwise, he’ll probably stick to his current regimen. I hope that’s okay.

[Vman1 in reply to MomOfMaisy]

So good to hear that he’s doing well.

[mababa]

Vman1, our profiles are are very similar. I’m on the two-year Orgovyx plus Zytiga regimen (following the Stampede Trial recommendations for N1MO patients). After 4 mos I’m still tolerating the regimen well, in my opinion. I’ll being getting a more in-depth evaluation from my new MO next month.

[Vman1 in reply to mababa]

Thank you. Glad to hear you’re tolerating the treatment. Best wishes to you.

[JohnInTheMiddle]

I'm on Firmagon / Degarelix, also a GnRH antagonist. 28 day injections. Orgovyx/ Relugolix once-a-day sounds great. But don't get arrested. Or otherwise lead an irregular lifestyle. Pills must be taken same time every day. Can't miss a day! Orgovyx pharmacokinetics are very fast cycle. If you're late even by a portion of a day, not to mention the whole day or two days, big T will be back in a jiffy, waking up all those sleepy assassins. And from what, I hear meds are not well managed in jail . . . plan ahead.

[Jazzman2023 in reply to JohnInTheMiddle]

Agree, John. I'm on Orgovyx (Just had my 1 year anniversary with it, woo hoo), and have learned that diligence and being regular with daily doses is the key. Same with the erleada/apalutamide I'm on, after I flunked out of the Zytiga/prednisone club last spring, lol, due to extremely elevated liver profiles.

[JohnInTheMiddle in reply to Jazzman2023]

Bravo Jazzman! I'm still on Abiratarone / Zytiga. So far so good.

[Vman1]

😀 the advantage of being a law abiding retired person. But a very good point indeed.

[JohnInTheMiddle in reply to Vman1]

When one thinks about it, there are lots of potential disruptions that might cause one to be separated from one's home and supply of Orgovyx / Relugolix in any given year.

Forest fires and floods come to mind, both of which have affected huge number of people in United States in the past 12 months. What about just visiting family and there's a power outage and a curfew? Or a car breakdown and you can't really afford an Uber? You can think of your own reasons to worry.

It's not unusual for people to travel locally, or to visit family in another town. After all, many of us who might be eligible for Orgovyx will have grandchildren. So as a precaution for a short trip or sensibly for a few days or longer, do we take Orgovyx with us?

It's highly recommended that it stays in its bottle or blister pack. And it needs to be stored at less than 86° Fahrenheit or 30° C. That's a significantly less than body temperature.

For another drug which I was carrying in a pill bottle in a breast pocket in a jacket, I was surprised to find out how warm the bottle was. But of course body temperature is higher than the two temperatures listed above! So you can't carry it next to your body.

Following a regimen for something like Orgovyx where "you really need to follow the regimen" is easy most days. But we need to be able to follow it every darn day. "Most days" isn't good enough.

And especially, stay out of jail. Staying out of jail is always a good plan, but now we have another reason to do so.