Luteinizing hormone-releasing hormone antagonist cetrorelix as primary single therapy in patients with advanced prostatic cancer and paraplegia due to metastatic invasion of spinal cord

This clinical trial, conducted by Schally (Nobel Laureate in Medicine 1977) and colleagues in Mexico, was one of the first clinical demonstrations of the use of cetrorelix as primary monotherapy in advanced prostate cancer treatment. The context was particularly critical: five patients presented with paraplegia from spinal cord compression due to vertebral metastases, a condition in which LHRH agonists (leuprolide, goserelin) are contraindicated due to the risk of flare-up — the initial transient testosterone surge that can worsen neurological compression.

Cetrorelix, being a competitive GnRH receptor antagonist, suppresses LH, FSH, and testosterone immediately after the first administration, without the testosterone surge characteristic of agonists. Patients received subcutaneous cetrorelix at adjusted doses and were followed for months.

Results were clinically remarkable: testosterone dropped to castration levels rapidly, all five patients regained the ability to walk with cane assistance within 3 months, and PSA levels gradually declined. In one patient, documented improvement of spinal compression on imaging was observed. No serious adverse effects were reported, and no patient experienced neurological worsening during treatment.

This work was important in demonstrating that cetrorelix offers a safe alternative to LHRH agonists precisely in the clinical scenarios where flare-up poses significant risk (vertebral metastases, urethral obstruction, severe bone pain). Although long-acting agonists remain the standard in most prostate cancer patients, the Gonzalez-Barcena study established a lasting clinical niche for GnRH antagonists in high-risk situations.