prostate cancer Flashcards
Hormone Therapy
androgen deprivation (FIRST LINE)
or blocking testosterone production
or blocking testosterone from getting to receptors
GOAL: decrease testosterone to < 50 ng/dL so hormone sensitive cancers don’t progress
LHRH Agonists
Leuprolide, Goserelin, Triptorelin Histrelin
as effective as surgical castration
slow onset (need to downregulate receptors): 2 - 4 weeks
SQ or IM
AEs
short term: TUMOR FLARE, hot flushes, headache, decreased libido, fatigue, erectile dysfunction, impotence, edema, gynecomastia, injection site reactions
long term: increased lipids, CV dx, diabetes, osteoporosis, obesity
- Monitoring **
- PSA levels
- testosterone
LHRH Antagonists
Degarelix
no tumor flare, so onset within 1 week
SQ administration monthly
** AEs **
Injection site reactions
Antiandrogens
inhibits DHT binding to receptors
- Administration **
- with LHRH agonist for first 7 days to prevent tumor flare
- not as monotherapy
- AEs **
- gynecomastia
- breast tenderness
- hot flashes
- LFT abnormalities
Bicalutamide
Anti Androgen
hepatotoxic
monitor LFTs
Flutamide
Anti Androgen
BBW: Hepatotox
Monitor LFTs
Nilutamide
Anti Androgen
BBW: interstitial pneumonia
Hepatotoxicity
visual accommodation issues
- Monitoring **
- routine CXR
Androgen Deprivation Tx AEs and monitoring
changes in mood, fatigue, increased body fat, less lean muscle, decreased libido, erectile dysfunction, gynecomastia, depression, hot flashes, osteoporosis, hair loss, metabolic syndrome
** Monitoring **
Blood pressure, lipids, glucose, HgA1c (w/in 3 - 6 months and periodically), DXA scan every 1 - 2 years, LFTs
Androgen Deprivation AE Management
Calcium and Vitamin D (if > 50 yo) to prevent decreased BMD
Sipuleucel-T
Immunotherapy
indicated for a-sx metastatic castrate-recurrent prostate cancer (mCRPC) with > 6 mo to live and no liver metastases
** procedure **
leukapheresis, exposure to immune stimulating agent + prostatic acid phosphatase then reinfusion into patient
** Administration **
q2 weeks, 3 doses total
- $90,000
- pre-med with acetaminophen and H1/H2RAs to prevent infusion rxns
- AEs **
- Infusion reaction
- strokes and MI
- thromboembolic events
abiraterone
CYP17A1 inhibitor
First line for chemo naive, a-sx men with mCRPC
- Admin **
- with prednisone to prevent hypoadrenalism
- 1 hour before or 2 hours after meals, as food increases AUC
- AEs **
- hypertension
- hypokalemia
- fatigue
- arthralgias
- edema
- hepatic dysfunction
- Monitoring **
- BP monthly
- serum K monthly
- LFTs q2 wks for 3 months, then monthly
- DDIs**
- CYP3A4 substrate
enzalutamide
antiandrogen, 2nd gen, pure androgen receptor antagonist
indicated for a-sx, chemo naive men with mCRPC
- AEs **
- BBW seizures
- hot flashes
- fatigue
- diarrhea
- headache
- back pain
- Monitoring **
- for seizures and dizziness
- DDIs **
- CYP3A4 substrate
- CYP2C8 substrate
Docetaxel
indicated for symptomatic mCRPC
- Administration **
- with prednisone
- premed with dexamethasone 3 days prior to tx
- AEs **
- BBW: Hypersensitivity (due to polysorbate IV vehicle)
- BBW: Fluid retention: peripheral edema requiring
- peripheral neuropathy
- myelosuppression
- hepatotoxicity
- Monitoring **
- weight at each visit
- CBC with differential
- LFTs
Cabazitaxel
indicated for symptomatic mCRPC if failed docetaxel b/c activity for resistant tumors
- Administration **
- given with prednisone
- premed with diphenhydramine, steroids and H2RA
- with G-CSF to prevent myelosuppression
- AEs **
- BBW: hypersensitivity reaction (due to polysorbate)
- BBW: myelosuppression
- peripheral neuropathy
- hepatotoxicity
- diarrhea
- *Monitoring**
- do not give if ANC < 1.5
- LFTs
- CBC with diff
Managing bone metastasis
palliative radiation
zolendronic acid, denosumab, alendronate
** Monitoring **
jaw osteonecrosis (need to keep up good oral hygiene!)
-hypocalcemia (denosumab especially)
- renal function (no zoledronic acid if CrCl < 30)
