B.35. Cancer chemotherapy IV (hormonal agents)

Question 1

common side effects of hormonal therapy

Answer 1

Vasomotor symptoms (sweating, hot flushes)
metabolic alterations
musculoskeletal presentations
↑ risk of venous thromboembolism

Question 2

list the hormonal anticancer agents

Answer 2

Prednisolone 
Tamoxifen 
Anastrozole 
Goserelin
Degarelix
Bicalutamide
octreotide

Question 3

what is the role of prednisolone as a hormonal anticancer agent?

Answer 3

1. activates glucocorticoid receptors that alter gene transcription
2. immunosuppressive effect–> inhibits each inflammatory phase
3. induces apoptosis (lymphoma)
4. improves appetite
5. ↓ ICP &nausea (brain &spinal tumors)

Question 4

in what type of cancers do we use prednisolone?

Answer 4

Acute leukemias (ALL)
Hodgkin's lymphoma 
non-Hodgkin's lymphoma 
brain & spinal tumors 
bone metastases (↓ pain)

Question 5

side effects of prednisolone (as an anticancer agent)

Answer 5

tumor lysis syndrome (lymphoma)

Iatrogenic Cushing syndrome (GC effect)

Question 6

what is Tamoxifen?

Answer 6

selective estrogen receptor modulator (SERM)

Question 7

Where does tamoxifen express estrogen antagonist action?

Answer 7

breast, uterus, CNS

Question 8

Where does tamoxifen express estrogen agonist action?

Answer 8

liver
bone

*partial agonist in the endometrium

Question 9

indications for Tamoxifen

Answer 9

Breast cancer (estrogen receptor-positive disease)
prophylaxis in women with high risk for breast cancer

Question 10

side effects of tamoxifen

Answer 10

nausea, vomiting
hot flushes 
vaginal bleeding 
thromboembolic events
endometrial hyperplasia and neoplasia--> ↑ risk of endometrial cancer

Question 11

what is Anastrozole?

Answer 11

Aromatase inhibitor

Question 12

when is Anastrozole used?

Answer 12

Breast cancer (advanced disease)
Tamoxifen resistant cancer

Question 13

side effects of Anastrozole

Answer 13

nausea, vomiting, diarrhea
hot flushes
musculoskeletal disorders (joint+bone pain)
bone mineral density is altered

Question 14

what is Goserelin?

Answer 14

GnRH agonist

synthetic peptide

Question 15

what does Goserelin do?

Answer 15

inhibits the release of FSH and LH –> both androgen and estrogen syntheses are reduced

Question 16

when do we use Goserelin?

Answer 16

Breast cancer
prostate cancer
Leiomyoma
endometriosis

Question 17

side effects of Goserelin

Answer 17

headaches, nausea
injection site reaction
symptoms of hypogonadism with continuous treatment (impotence in male)

Question 18

what is Degarelix?

Answer 18

GnRH antagonist

Question 19

what is the effect of Degarelix

Answer 19

alters the release of FSH and LH—> ↓ testosterone synthesis

Question 20

when do we use Degarelix?

Answer 20

advanced, metastatic prostate cancer

Question 21

side effects of Degarelix?

Answer 21

headaches, vomiting, nausea

Question 22

what is Bicalutamide?

Answer 22

androgen receptor inhibitor

*inhibits the growth of hormone-dependent prostate cancer

Question 23

when is bicalutamide used?

Answer 23

prostate cancer

never in monotherapy! always in combination with GnRH analogs (e.g leuprolide)

Question 24

side effects of bicalutamide

Answer 24

gynecomastia
hot flashes 
impotence 
hepatotoxicity 
osteoporosis (lung run)

Question 25

what is octreotide?

Answer 25

somatostatin (GHIH) analog

Question 26

what does octreotide do?

Answer 26

inhibit the release of GH, insulin, glucagon and gastrin

Question 27

indications for octreotide?

Answer 27

1. endocrine tumor–> carcinoid, gastrinoma, glucagonoma, insulinoma, VIPoma
2. Acromegaly

Question 28

side effects of octreotide

Answer 28

GI disturbances

gall stones