B.35. Cancer chemotherapy IV (hormonal agents) Flashcards
common side effects of hormonal therapy
Vasomotor symptoms (sweating, hot flushes)
metabolic alterations
musculoskeletal presentations
↑ risk of venous thromboembolism
list the hormonal anticancer agents
Prednisolone Tamoxifen Anastrozole Goserelin Degarelix Bicalutamide octreotide
what is the role of prednisolone as a hormonal anticancer agent?
- activates glucocorticoid receptors that alter gene transcription
- immunosuppressive effect–> inhibits each inflammatory phase
- induces apoptosis (lymphoma)
- improves appetite
- ↓ ICP &nausea (brain &spinal tumors)
in what type of cancers do we use prednisolone?
Acute leukemias (ALL) Hodgkin's lymphoma non-Hodgkin's lymphoma brain & spinal tumors bone metastases (↓ pain)
side effects of prednisolone (as an anticancer agent)
tumor lysis syndrome (lymphoma)
Iatrogenic Cushing syndrome (GC effect)
what is Tamoxifen?
selective estrogen receptor modulator (SERM)
Where does tamoxifen express estrogen antagonist action?
breast, uterus, CNS
Where does tamoxifen express estrogen agonist action?
liver
bone
*partial agonist in the endometrium
indications for Tamoxifen
Breast cancer (estrogen receptor-positive disease) prophylaxis in women with high risk for breast cancer
side effects of tamoxifen
nausea, vomiting hot flushes vaginal bleeding thromboembolic events endometrial hyperplasia and neoplasia--> ↑ risk of endometrial cancer
what is Anastrozole?
Aromatase inhibitor
when is Anastrozole used?
Breast cancer (advanced disease) Tamoxifen resistant cancer
side effects of Anastrozole
nausea, vomiting, diarrhea
hot flushes
musculoskeletal disorders (joint+bone pain)
bone mineral density is altered
what is Goserelin?
GnRH agonist
synthetic peptide
what does Goserelin do?
inhibits the release of FSH and LH –> both androgen and estrogen syntheses are reduced
when do we use Goserelin?
Breast cancer
prostate cancer
Leiomyoma
endometriosis
side effects of Goserelin
headaches, nausea
injection site reaction
symptoms of hypogonadism with continuous treatment (impotence in male)
what is Degarelix?
GnRH antagonist
what is the effect of Degarelix
alters the release of FSH and LH—> ↓ testosterone synthesis
when do we use Degarelix?
advanced, metastatic prostate cancer
side effects of Degarelix?
headaches, vomiting, nausea
what is Bicalutamide?
androgen receptor inhibitor
*inhibits the growth of hormone-dependent prostate cancer
when is bicalutamide used?
prostate cancer
never in monotherapy! always in combination with GnRH analogs (e.g leuprolide)
side effects of bicalutamide
gynecomastia hot flashes impotence hepatotoxicity osteoporosis (lung run)
what is octreotide?
somatostatin (GHIH) analog
what does octreotide do?
inhibit the release of GH, insulin, glucagon and gastrin
indications for octreotide?
- endocrine tumor–> carcinoid, gastrinoma, glucagonoma, insulinoma, VIPoma
- Acromegaly
side effects of octreotide
GI disturbances
gall stones
