Anti-hormone Therapies/Prostate Cancer Flashcards
1
Q
Anti-Hormone Therapies
A
- Act to reduce the ability of steroid hormones to activate their receptors
- Done by reducing hormone production or inhibiting the activation of their receptors with an antagonist
- Only useful for cancers that are hormonal responsive!
2
Q
Leuprolide/Goserelin
A
- LHRH agonists
- Small peptides of gonadotropin releasing hormones that act as GnRH agonists
- Initially increase FSH and LH followed by suppression d/t desensitization of pituitary GnRH
- LH/FSH stimulate progesterone/estrogen/testosterone release which can stimulate their prospective cancers
3
Q
Abiraterone Acetate
A
- Zytiga
- Inhibits 17alpha-hydroxylase which inhibits steroid hormone production
- Used to treat advanced hormone-responsive prostate cancer
4
Q
Anastrazole/Letrozole
A
- Arimidex/Femara
- Inhibits aromatase which inhibits estrogen production
- Used to treat metastatic, hormone responsive breast cancer (ER+)
5
Q
SERMs
A
- Selective Estrogen Receptor Modulators
- Tamoxifen: requires metabolic activation to endoxifen, tissue dependent, used as ER antagonist in breast cancer
- Raloxifene: used in breast cancer prevention and for osteoporosis in postmenopausal women
6
Q
Estrogen Receptor Antagonists
A
- Fulvestrant, Toremifene (in postmenopausal women)
- Used for metastatic breast cancer
7
Q
Megestrol Acetate
A
- Progestin - decreases estradiol production
- Used in breast, endometrial, and renal cell cancers
8
Q
Androgen Receptor Antagonists
A
- Enzulatamide - potent androgen receptor antagonist for advanced, castration resistant prostate cancer
- Bicalutamide - non-steroidal androgen receptor antagonists (used less)
9
Q
Prostate Gland
A
- Exocrine gland of the male reproductive system
- Surround urethra just below the bladder
- BPH, Prostatitis, and prostate cancer are possible pathologies
10
Q
Prostate Cancer Diagnosis
A
- Staging determines therapy - complex and involved designation (AJCC TNM)
- TNM designation, PSA level, and Gleason score from biopsy all determine therapy
- Start with androgen deprivation therapy
- Can be used as neoadjuvant/adjuvant therapy, for metastatic disease, and can include antiandrogen or LHRH agonists
- Chemotherapy for castration-resistant prostate cancer
11
Q
SE from ADT
A
- Impotence
- Hot flashes
- Reduced/absent sex drive
- Breast tenderness
- Osteoporosis
- Decreased mental sharpness
- Loss of muscle mass
- Weight gain
- Fatigue
- Depression
- Increased cholesterol levels
- Anemia
12
Q
mCRPC
A
- Metastatic Castration-Resistant Prostate Cancer
- Use chemotherapy
- Docetaxel (increases survival) and Olaparib
- Supportive therapies: zoledronic acid, alendronate, denosumab
- Alternatives: Cabazitaxel, Mitoxantrone
- Radiopharmaceutical options: radium-223 and samarium-153
- Checkpoint inhibitors: Pembrolizumab (anti-PD1 antibody)
- Immunotherapies: Sipuleucel-T (vaccine)
13
Q
Sipuleucel-T
A
- Provenge
- Autologous dendritic cells are isolated from patient’s blood sample by leukapheresis
- Cell cultured ex vivo with a fusion protein which enhances immune response
- Antigen-presenting cells take up these antigens and then reinfused into the same patient to stimulate T-cell response
- Risk of inappropriate immune activation is low since it’s the patient’s own dendritic cells
14
Q
NSAA Monotherapy
A
- Not recommended
- Survival better with androgen deprivation/NSAA combination therapy
- Survival is small but QoL advantage with NSAA is large
15
Q
LHRH QoL Impact
A
- Sexual dysfunction
- Loss of energy/sharpness
- Increased CVS
