This study will compare the incidence of major adverse cardiovascular events (MACEs) with androgen deprivation therapy (ADT) among men with advanced prostate cancer who are being treated with a gonadotropin-releasing hormone (GnRH) antagonist versus a GnRH agonist.
Treatment of advanced prostate cancer with ADT might increase the risk of subsequent cardiovascular events among men with known atherosclerotic cardiovascular disease (ASCVD), but a recent meta-analysis suggested that this risk might be lower with ADT using a GnRH antagonist versus a GnRH agonist.
PRONOUNCE is a multicenter, prospective, randomized, open, blinded endpoint trial that will enroll approximately 900 patients with advanced prostate cancer and pre-existing ASCVD who will be treated with ADT. Participants will be randomized to receive the GnRH antagonist degarelix or the GnRH agonist leuprolide as ADT for 12 months. The primary endpoint is time from randomization to first confirmed, adjudicated occurrence of a MACE, which is defined as a composite of all-cause death, nonfatal myocardial infarction, or nonfatal stroke through 12 months of ADT treatment. Baseline cardiovascular biomarkers (high-sensitivity C-reactive protein, high-sensitivity troponin T, and N-terminal pro-brain natriuretic peptide), as well as serial inflammatory and immune biomarkers, will be evaluated in exploratory analyses.
As of October 1, 2019, a total of 364 patients have been enrolled. The mean age is 74 years, 90% are white, 80% have hypertension or dyslipidemia, 30% diabetes mellitus, 40% have had a previous myocardial infarction, and 65% have had previous revascularization. Regarding prostate cancer features at randomization, 48% of the patients had localized disease, 23% had locally advanced disease, and 18% had metastatic disease.
PRONOUNCE is the first prospective cardiovascular outcomes trial in advanced prostate cancer that will delineate whether the risk of subsequent cardiovascular events associated with ADT is lower with a GnRH antagonist versus a GnRH agonist for men with pre-existing ASCVD. (A Trial Comparing Cardiovascular Safety of Degarelix Versus Leuprolide in Patients With Advanced Prostate Cancer and Cardiovascular Disease [PRONOUNCE]; NCT02663908).
JACC. CardioOncology. 2020 Mar 17*** epublish ***
Chiara Melloni, Susan F Slovin, Allan Blemings, Shaun G Goodman, Christopher P Evans, Jan Nilsson, Deepak L Bhatt, Konstantin Zubovskiy, Tine K Olesen, Klaus Dugi, Noel W Clarke, Celestia S Higano, Matthew T Roe, PRONOUNCE Investigators
Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA., Department of Medicine, Division of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Ferring Pharmaceuticals A/S, Copenhagen, Denmark., Department of Medicine, Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada., Department of Urologic Surgery, University of California, Davis, Sacramento, California, USA., Department of Clinical Sciences Malmö, Lund University, Lund, Sweden., Division of Cardiovascular Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA., Ferring Pharmaceuticals A/S, Parsippany, New Jersey, USA., Ferring Pharmaceuticals A/S, Saint-Prex, Switzerland., Division of Urology, Institute of Cancer Sciences, University of Manchester, United Kingdom., Division of Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.