From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Firmagon (degarelix) should be continued indefinitely for patients with metastatic prostate cancer, as long as the patient is responding to treatment and tolerating it well. This medication is a gonadotropin-releasing hormone (GnRH) antagonist that works by rapidly suppressing testosterone levels, which is essential for controlling metastatic prostate cancer. Unlike other hormonal therapies, Firmagon provides immediate testosterone suppression without an initial surge. The standard regimen involves a starting dose of 240 mg administered as two 120 mg subcutaneous injections, followed by monthly maintenance injections of 80 mg.
Key Considerations
- Treatment interruption would likely result in rising testosterone levels and potential disease progression.
- Regular monitoring of PSA levels, testosterone levels, and imaging studies should be performed to assess treatment response, as recommended by studies such as 1 and 2.
- Side effects may include injection site reactions, hot flashes, weight gain, and increased risk of cardiovascular events, as noted in studies like 3 and 4.
- If disease progression occurs despite Firmagon therapy, additional treatment options should be considered, but the GnRH antagonist therapy is typically maintained as part of the treatment backbone even when adding other agents, as suggested by 5.
Evidence Summary
The evidence from studies 1, 3, and 2 supports the use of degarelix for the treatment of advanced prostate cancer, demonstrating its efficacy in suppressing testosterone levels and improving disease control. While study 5 highlights the importance of symptom management and treatment strategies in metastatic prostate cancer, it does not directly address the duration of Firmagon treatment. Study 4 provides detailed information on the pharmacology and clinical data of degarelix, further supporting its use in prostate cancer treatment.
Clinical Implications
Given the evidence, continuing Firmagon indefinitely is recommended for patients with metastatic prostate cancer who are responding to treatment and tolerating it well, to maintain testosterone suppression and control disease progression. Regular monitoring and management of side effects are crucial to ensure the patient's quality of life.