Episode 324: Pharmacology 101: LHRH Antagonists and Agonists
Release Date: 08/09/2024
The ONS Podcast
“Biomarker testing isn’t just about generating more information. It’s about answering very practical questions for our patients. Can we identify disease earlier? Can we understand whether treatment is working? Are we able to identify why a cancer has become resistant? Ultimately, I think that’s where precision oncology becomes very meaningful. It’s not about the molecular report sitting in the chart. It’s about taking that information and using it to make the best possible decision for our individual patients,” ONS member Erica Bello Rodriguez, MSN, AGNP, NP-C, AOCNP®, oncology...
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“The most important thing related to hypersensitivity reactions is that there is often a potential for rapid progression, and that’s what makes these reactions an oncologic emergency. The patients may have symptoms that are mild, and that quickly can progress to respiratory compromise, hypertension, cardiovascular issues, or anaphylaxis. Early recognition is so important, so we don’t want to wait for our patient to become hypotensive or significantly hypoxic before we identify that they’re having a serious reaction,” ONS member Christina Matousek, DNP, RN, OCN®, patient education...
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“The accumulation of these malignant and reactive cells, that’s what causes the lymph nodes to get big. That’s why they grow. And that’s why the classic presentation is persistent, painless, enlarged lymph nodes. So when we think of the pathophysiology of Hodgkin lymphoma, there are really two processes contributing to the presentation: One is the physical effects of enlarging lymph nodes or the involved organs. The second is the systemic inflammatory response generated by it and its surrounding immune environment,” ONS member Victoria Krogg, DNP, APRN-CNP, AOCNP®, nurse...
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“Nurses are the front line. Oncology nurses see their patients almost all day. If you’re noticing that anxiety is causing significant distress or anxiety is disrupting a patient’s ability to concentrate during medical conversations or decision-making—anytime you’re seeing significant distress or disruption to functioning, that’s a pretty good indicator that referral to a psychiatric nurse and psychiatric care could be very helpful for that patient,” Amber Altidor, DNP, APRN-FPA, PMHNP-BC, assistant professor at Rush University College of Nursing and psychiatric nurse practitioner...
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“Unlike our cancer indications where we use these medications often to activate the immune system to target cancerous cells, in noncancer indications, the goal is really to either suppress an overactive immune or inflammatory cells or modulate the immune system. Immune modulation by use of chemotherapy and immunotherapy can help reduce abnormal inflammation, decrease autoantibody production, and also can alter T-cell and B-cell activity,” ONS member Kelsey Miller, MSN, RN, AGCNS-BC, OCN®, clinical nurse specialist in oncology and infusion therapy at Reading Hospital in West Reading, PA,...
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“It’s a chronic disease. It never goes away for some people, and so therefore it has these periods of remission where it’s really quiet and well controlled. Then there can be periods of flares where you’re actively engaged in treatment or it’s impacting other pieces. There’s this feeling patients have of, ‘When am I going to have that flare?’ You know, this anticipatory anxiety of, ‘When are things going to be done differently?’ or ‘When do I need to change?’” ONS member Caitlin Murphy, DNP, APRN, FNP-BC, AOCNP®, chief nurse practitioner at Dana-Farber Cancer...
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“Think about all the important things our kidneys do for the body. Those things are compromised. If we have excess buildup of toxins and waste in the body, you’re having problems with fluid reabsorption. Then you have also problems with electrolytes not being balanced. Then in turn, you have ongoing shutdown of systems. So the cardiopulmonary system gets compromise. Your circulatory system then gets compromised. And then all the things in the body that depend upon ongoing circulatory flow are then causing major resets in the system that need to be addressed,” ONS member Brenda S....
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“If you are considering board service, I would say take the leap. Start with your local chapter. It will give you some valuable skills that will help prepare you when you are applying for your national level. And I always say, if you want to do it, just do it because what’s the worst that can happen? They can say no, but that doesn’t mean that you will never serve on a board. I always tell people delayed is not denied,” Cassandra Green, DNP, RN, OCN®, ONS member and past president of the Oncology Nursing Certification Corporation (ONCC) Board of Directors, told Evelyn Wempe, DNP,...
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“They’re really worried that radiation is going to be painful. So they come in for that first day of treatment very anxious. With our patients with brain cancer, we’re using the masks on the table, and those masks are very tight and hold their heads very, very still. So they’ll be very worried about being claustrophobic. We may start out the first day or two with a little bit of [lorazepam]. And they’ll come to me and they’ll say, ‘This really hasn’t been as bad as I thought it was going to be,’” ONS member Catherine McCluskey, BSN, RN, OCN®, ROCN™, radiation oncology...
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“Measurable residual disease is where I think the terminology fits best in that, it is intended to measure the amount of cancer cells that are present in the blood or bone marrow at the time the sample was collected. We can identify one cancer cell in a million. Where that can be really valuable is when we start to think about the duration of treatments and the response to some of our treatments,” ONS member Caitlin Murphy, DNP, APRN, FNP-BC, AOCNP®, chief nurse practitioner at Dana-Farber Cancer Institute in Boston, MA, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical...
info_outline“A lot of the efforts have been made to improve the patient experience for these treatments, as they can be given for years at a time. For example, when leuprolide debuted way back in 1985, it was a daily injection. But four years later, they developed the monthly depo formulation. Now we have formulations that are approved for administration once only every three, four, and even six months,” Andrew Ruplin, PharmD, clinical oncology pharmacist at Fred Hutchinson Cancer Center in Seattle, WA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about the luteinizing hormone–releasing hormone (LHRH) antagonist and agonist drug classes.
Music Credit: “Fireflies and Stardust” by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by August 9, 2025. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.
Learning outcome: Learners will report an increase in knowledge related to LHRH antagonists and agonists.
- Episode Notes
- The NCPD activity for this episode has expired, but you can still earn NCPD through many other Oncology Nursing Podcast episodes. Find a full list of opportunities.
- Oncology Nursing Podcast episodes:
- Pharmacology 101 series
- Episode 321: Pharmacology 101: CYP17 Inhibitors
- Episode 242: Oncology Pharmacology 2023: Today’s Treatments and Tomorrow’s Breakthroughs
- Episode 154: New Drug Approvals for Metastatic Castration-Sensitive Prostate Cancer
- Episode 113: Manage Cancer-Related Hot Flashes With ONS Guidelines™
- ONS Voice article: Oncology Drug Reference Sheet: Relugolix
- ONS books:
- ONS course: Safe Handling Basics
- ONS Guidelines™ and Symptom Interventions
- ONS Huddle Card: Hormone Therapy
- ONS Learning Libraries:
- Oral Chemotherapy Education Sheets
- National Comprehensive Cancer Network
- On the Treatment of Inoperable Cases of Carcinoma of the Mamma: Suggestions for a New Method of Treatment, With Illustrative Cases (by George T. Beatson)
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an Oncology Nursing Podcast™ Club in your chapter or nursing community, visit the Oncology Nursing Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email [email protected].
Highlights From This Episode
“Between all of these agonists and antagonists, there’s a broad spectrum of applications, including hormone-positive breast cancer, androgen-deprivation therapy for prostate cancer, uterine cancer, and then other non-cancer uses like uterine fibroids, and assisted reproduction fertility treatments, and other things too.” TS 3:24
“In the education of my female patients, I basically use the analogy that it is functionally inducing menopause in that person, so there can be changes to mood and cognition, energy level fatigue, body morphology, and shifts in fat distribution metabolism, which can unfortunately increase the risk of cardiovascular disease. One that almost everyone’s familiar with is hot flashes, but also changes to bone mineral density, libido and physically to atrophy and dryness of vaginal mucosa, which can make sex for our patients more difficult as well.” TS 10:33
“A concept that’s familiar to all professionals in the care of prostate cancer is that because LHRH agonists cause an initial increase in testosterone, which can, in essence, feed the cancer, some patients can experience worsening symptoms of their cancer, such as difficulty voiding their bladder pain, or even vertebral collapse or spinal cord compression when bone metastases are present. This is a really serious issue that should be considered ahead of starting an agonist in these patients.” TS 12:39
“I don’t think we’ll see any dramatic changes in treating breast cancer, since the role of these agents is a lot more limited and simply really exist to suppress estrogen and premenopausal patients. But as a referral center that routinely sees patients with breast cancer and their 40s and 30s and even their 20s, it’s crucial to consider these agents in their role for not only actively treating certain types of breast cancer, but also in preserving fertility for patients who desire to have children and they are receiving gonadotoxic chemotherapy.” TS 25:32