Hormonal Therapy

Question 1

Ablative vs Additative vs Adjuvant

Answer 1

• Ablative: blocks hormone production. Radio frequency ablation, GnRH-analogues.
• Additative: hormone supplementation via hormone agonists. Estrogens, Progestins, Somatostatin analogues, glucocorticoids.
• Adjuvant: in addition to main treatment. Aromatase inhibitors, 5a-reductase inhibitors, Anti-estrogens, Anti-androgens.

Question 2

GnRH-analogues

Answer 2

Goserelin.

• Overstimulate LH+FSH release, leading to a decrease in its future release -> decrease ovarian estrogen and testicular testosterone (axis suppression).
• Prostate and Breast carcinomas. Also in chemical castration.
• AE: hot flushes, impotence

Question 3

Estrogens

Answer 3

Ethinylestradiol.

• Palliative treatment of prostate carcinoma, but replaced by GnRH due to AE. Not used in Breast cancer anymore.
• AE: thrombi, MI, Stroke, gynecomastia.

Question 4

Progestins

Answer 4

Megestrol acetate.

- In hormone responsive breast/prostate/endometrial. But replaced by aromatase inhibitors.

Question 5

Somatostatin analogues

Answer 5

Ocreotide.

• Inhibits production of growth hormone & other GIT hormones.
• Relieve symptoms of Neuroendocrine tumors.

Question 6

Glucocorticoids

Answer 6

Prednisone, Dexamethasone.

• Inhibit lymphocyte proliferation
• ALL, HL/NHL.

Question 7

Inhibitors of hormone synthesis

Answer 7

• Aromatase inhibitors:
- Anastrozole. Decr extraovarian synthesis of Estrogen. For Breast and ovarian.

• 5a-reductase inhibitors:
- Finasteride. Decr conversion of testosterone to DHT. Used in BPH, but also in Prostatic/testicular cancer.

Question 8

Hormone receptor antagonists

Answer 8

• Anti-estrogens:

• Tamoxifen, Raloxifen. SERMs. Downregulate receptors, DOC in Estrogen-Rc+ Breast cancer.
• AE: hot flushes, endometrial tumors, thromboembolism.

• Anti-androgens:
- Flutamide. Compete for androgen Rc. Used in prostate cancer.