From the Research
Nubeqa (darolutamide) can be used instead of Degarelix to prevent testosterone flare when starting Lupron (leuprolide) therapy. Darolutamide is an androgen receptor inhibitor that blocks testosterone action at the cellular level, effectively preventing the temporary surge in testosterone that occurs with GnRH agonists like Lupron. The typical approach would be to start darolutamide (600 mg twice daily with food) approximately 7-14 days before the first Lupron injection and continue it for about 4 weeks after starting Lupron, by which time testosterone levels should be adequately suppressed. This strategy works because darolutamide directly blocks testosterone's effects at the receptor level, while the body adjusts to the Lupron therapy. While Degarelix works by immediately suppressing testosterone production without causing a flare, darolutamide works differently by blocking testosterone's effects regardless of its level in the bloodstream. This approach is particularly useful for patients with symptomatic metastatic prostate cancer where a testosterone surge could worsen symptoms. However, this specific use of darolutamide is considered off-label, as it's primarily approved for non-metastatic castration-resistant prostate cancer and metastatic hormone-sensitive prostate cancer in combination with other therapies, as noted in studies such as 1. It's also worth noting that Degarelix has been shown to be effective in reducing testosterone levels and preventing clinical flare in patients with prostate cancer, as demonstrated in studies like 2 and 3. But, in terms of preventing testosterone flare, darolutamide can be a viable alternative to Degarelix, especially in cases where the latter is not available or suitable, as supported by the mechanism of action and clinical use described in the context of GnRH agonists like Lupron 4, 5. Key points to consider when using darolutamide in this context include:
- Starting dose and duration: 600 mg twice daily for 7-14 days before and 4 weeks after starting Lupron
- Mechanism of action: blocking testosterone effects at the receptor level
- Clinical context: particularly useful for symptomatic metastatic prostate cancer
- Off-label use: primarily approved for non-metastatic castration-resistant and metastatic hormone-sensitive prostate cancer.