Blue Book: Hormone Therapy for Cancer

Question 1

When can hormone therapy be used?

Answer 1

For ‘hormone-dependent’ cancers: rate of growth is influenced by levels of hormones, interfering with those hormones may lead to growth arrest and tumour regression.

Question 2

Which cancers are hormone sensitive?

Answer 2

Hormonal tissue cancers:
Sex hormones:
Prostate
Breast
Endometrium

Corticosteroids:
Lymphocytic Malignancies (lymphoma, leukaemia and myeloma:

Question 3

When can hormonal treatment be used?

Answer 3

Neo-Adjuvant (shrink primary)
Instead of surgery (primary)
Prevent/delay growth of micro mets after surgery (adjacent)
Shrink established mets (palliative)

Question 4

How can you remove the source of growth-promoting hormone?

Answer 4

Bilateral oophorectomy in pre-menopausal women/ bilateral orchidectomy in men. Remove sex hormones.

Permanent ovarian ablation induced by radiotherapy.

Medical castration: long-acting LHRH analogues. (goserelin): down regulate pituitary block LH and FSH production. This is not suitable in postmenopausal women as sex hormone is mainly extra-gonadal in fat and adrenals.

Aromatase inhibitors (prevent rate limiting step in oestrogen production) in post menopausal women occurs in fat/liver: anastrozole/exemestane/letrozole

Question 5

Function and examples of hormone inhibitors.

1 x female
2 x male

Answer 5

Block binding of hormones to tumour cell.
Eg Tamoxifen anti-oestrogen

Anti-androgens:

1. Steroidal ant-androgens: cyproterone acetate
   - inhibit androgen receptor and substitute testosterone in hypothalamus= negative feedback
2. Non-steroidal anti-androgens: bicalutamide
   - inhibit testosterone in tumour cells and hypothalamus (causes rise in serum test) = give LHRH analogue
   - used in prostate cancer

Question 6

When is increasing hormones level helpful?

3 scenarios.

Answer 6

Glucocorticoids in high concentrations induce apoptosis in malignant lymphoid cells.

Hormone supplementation in some sex-sensitive cancers to induce negative feedback loop.

Progestogens: orally high dose in progesterone sensitive tissues (breast & endometrium). Inhibit tumour growth by binding to PR and also produce negative feedback on pituitary/gonadal axis.