Presently Zytiga has been clinically trialled to show a greater than 30% response rate in the elimination of tumours when tried early on in the neoadjuvant setting in combination with Lupron injections.
Since Zytiga can work as a single agent to reduce testosterone levels to zero on its own there seems to be little point to using Lupron, and this raises the question "Should Zytiga be used as a front line agent taken with prednisone alone".
Lupron injections work at the adrenal axis to lower plasma testosterone via an LHRH feedback mechanism. However this does not reduce testosterone produced by the prostate cancer cells, but Zytiga does. So there is no logical reason to include Lupron at all, and the Zytiga plus Prednisone combo should work just as effectively on its own.
Clinical trials need to be conducted on this and should look at the use of low dose zytiga (one 250 mg tablet) daily taken shortly after eating, together with 5 mg of prednisone taken 4 hours later as first line neoadjuvant therapy for early stage prostate cancer.
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