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Injectable depot formulations of luteinizing hormone–releasing hormone (LHRH) agonists are the standard method of attaining androgen deprivation in men with advanced prostate cancer. However, these agents can cause an initial spike of testosterone (“testosterone flare”). Gonadotropin-releasing hormone (GnRH) antagonists provide rapid achievement of testosterone suppression without causing a testosterone flare.
To compare the efficacy and safety of an oral GnRH antagonist (relugolix) with that of an LHRH agonist (leuprolide) in this setting, investigators conducted an industry-sponsored, multinational, randomized, phase III study (HERO) of 930 patients with advanced prostate cancer; of these, >90% had excess risk for cardiovascular events. Pa…