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Estetrol Inhibits the Prostate Cancer Tumor Stimulators FSH and IGF-1.

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Androgen deprivation therapy (ADT) combined with estetrol (E4) significantly suppressed follicle-stimulating hormone (FSH) and insulin-like growth factor-1 (IGF-1) in advanced prostate cancer patients. This suggests E4 enhances ADT efficacy by reducing key tumor stimulators.

Keywords:
PCombi studyandrogen deprivation therapy (ADT)estetrol (E4)follicle-stimulating hormone (FSH)insulin-like growth factor-1 (IGF-1)

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Area of Science:

  • Endocrinology
  • Oncology
  • Pharmacology

Background:

  • Advanced prostate cancer (PCa) requires endocrine therapy, often androgen deprivation therapy (ADT).
  • Estetrol (E4), a fetal estrogen, is being investigated for co-treatment with ADT to enhance anti-cancer effects.
  • Previous studies indicated ADT+E4 suppressed testosterone and PSA; this study details FSH suppression and examines IGF-1 effects.

Purpose of the Study:

  • To evaluate the detailed effect of E4 co-treatment with ADT on follicle-stimulating hormone (FSH) suppression.
  • To assess the impact of ADT+E4 on insulin-like growth factor-1 (IGF-1) levels in advanced PCa patients.
  • To determine if E4 enhances the anti-tumor activity of ADT by modulating these key endocrine factors.

Main Methods:

  • A Phase II, double-blind, randomized, placebo-controlled study (PCombi) involving advanced PCa patients on ADT.
  • Patients were randomized to receive either 40 mg E4 or placebo for 24 weeks alongside ADT.
  • FSH and IGF-1 levels were monitored, with analyses performed on the per-protocol population.

Main Results:

  • ADT+E4 achieved near-complete FSH suppression in 98% of patients, compared to 37% with ADT alone (p < 0.0001).
  • IGF-1 levels decreased by 41% in the ADT+E4 group, whereas they increased by 10% in the ADT+placebo group (p < 0.0001).
  • These effects were observed consistently across individual patients in the ADT+E4 arm.

Conclusions:

  • ADT combined with E4 demonstrates potent suppression of the tumor stimulator FSH in all treated patients.
  • E4 augments the effects of ADT by significantly reducing IGF-1 levels, contrasting with the increase seen with ADT alone.
  • These findings suggest that E4 co-treatment may enhance the anti-cancer efficacy of ADT in advanced prostate cancer.