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? This article from the NEJM meta journals (NEJM Journal Watch) Does Transdermal Estrogen Therapy for Prostate Cancer Decrease Cardiovascular Toxicities percutaneous take estrogen therapy for prostate cancer reduces the possibility of cardiovascular toxicity comment author: Robert Dreicer, MD, MS, MACP, FASCO late Or patients with metastatic prostate cancer who use transdermal estrogen preparations or luteinizing hormone releasing hormone (LHRH) agonists in androgen deprivation treatment have similar cardiovascular outcomes.
LHRH agonists are the most widely used drugs in medical castration.
The initial non-surgical regimen was estrogen (diethylstilbestrol), but due to its association with increased thromboembolic events, and due to the emergence of LHRH agonists, estrogen has basically been abandoned.
Transdermal administration of estradiol may avoid first-pass liver metabolism associated with activation of the coagulation pathway.
In a phase 2/3 randomized trial, researchers compared the cardiovascular outcomes of patients with locally advanced or metastatic prostate cancer after receiving transdermal estrogen (TDE) patches and LHRH agonists.
During the 12 years, the researchers enrolled 1,694 patients in the United Kingdom who planned to receive long-term androgen deprivation treatment, and had no major cardiovascular disease in the past 2 years, and no myocardial infarction or thromboembolic events in the past 6 months ( Median age, 73 years old).
About 50% of patients had metastatic prostate cancer at the beginning of the study.
At 4 weeks, 65% and 83% of patients in the LHRH agonist group and 83% of the TDE group had castrated testosterone levels.
During a median follow-up of 3.
9 years, 8% and 10% of patients in the two groups had at least one cardiovascular event.There was no difference between the two groups in terms of the time to the first cardiovascular event and the nature of the event.
The total incidence of fatal cardiovascular events was 2%, and there was no significant difference between the two treatment groups.
Comment This high-quality study provides more prospective data on the cardiovascular toxicity of estrogen and LHRH agonists.
As described by the authors, compared with LHRH agonists, TDE can reduce bone density decline, hot flashes, and metabolic changes.
Commented articles Langley RE et al.
Transdermal oestradiol for androgen suppression in prostate cancer: Long-term cardiovascular outcomes from the randomised Prostate Adenocarcinoma Transcutaneous Hormone (PATCH) trial programme.
Lancet 2021 Feb 13; 397:581.
(https://doi .
org/10.
1016/S0140-6736(21)00100-8) Related reading NEJM Journal Watch The NEJM Journal Watch is published by NEJM Group.
Internationally renowned doctors are invited to comment on important papers in the medical field to help doctors understand and use the latest developments.
.
"NEJM Frontiers of Medicine" is translated several times a week, published on the app and official website, and selected 2-3 articles are published on WeChat.
Copyright information This article was translated, written or commissioned by the "NEJM Frontiers of Medicine" jointly created by the Jiahui Medical Research and Education Group (J-Med) and the "New England Journal of Medicine" (NEJM).
The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities.
LHRH agonists are the most widely used drugs in medical castration.
The initial non-surgical regimen was estrogen (diethylstilbestrol), but due to its association with increased thromboembolic events, and due to the emergence of LHRH agonists, estrogen has basically been abandoned.
Transdermal administration of estradiol may avoid first-pass liver metabolism associated with activation of the coagulation pathway.
In a phase 2/3 randomized trial, researchers compared the cardiovascular outcomes of patients with locally advanced or metastatic prostate cancer after receiving transdermal estrogen (TDE) patches and LHRH agonists.
During the 12 years, the researchers enrolled 1,694 patients in the United Kingdom who planned to receive long-term androgen deprivation treatment, and had no major cardiovascular disease in the past 2 years, and no myocardial infarction or thromboembolic events in the past 6 months ( Median age, 73 years old).
About 50% of patients had metastatic prostate cancer at the beginning of the study.
At 4 weeks, 65% and 83% of patients in the LHRH agonist group and 83% of the TDE group had castrated testosterone levels.
During a median follow-up of 3.
9 years, 8% and 10% of patients in the two groups had at least one cardiovascular event.There was no difference between the two groups in terms of the time to the first cardiovascular event and the nature of the event.
The total incidence of fatal cardiovascular events was 2%, and there was no significant difference between the two treatment groups.
Comment This high-quality study provides more prospective data on the cardiovascular toxicity of estrogen and LHRH agonists.
As described by the authors, compared with LHRH agonists, TDE can reduce bone density decline, hot flashes, and metabolic changes.
Commented articles Langley RE et al.
Transdermal oestradiol for androgen suppression in prostate cancer: Long-term cardiovascular outcomes from the randomised Prostate Adenocarcinoma Transcutaneous Hormone (PATCH) trial programme.
Lancet 2021 Feb 13; 397:581.
(https://doi .
org/10.
1016/S0140-6736(21)00100-8) Related reading NEJM Journal Watch The NEJM Journal Watch is published by NEJM Group.
Internationally renowned doctors are invited to comment on important papers in the medical field to help doctors understand and use the latest developments.
.
"NEJM Frontiers of Medicine" is translated several times a week, published on the app and official website, and selected 2-3 articles are published on WeChat.
Copyright information This article was translated, written or commissioned by the "NEJM Frontiers of Medicine" jointly created by the Jiahui Medical Research and Education Group (J-Med) and the "New England Journal of Medicine" (NEJM).
The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities.
