Anti-hormone Therapies/Prostate Cancer Flashcards Preview

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Flashcards in Anti-hormone Therapies/Prostate Cancer Deck (20)
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1
Q

Anti-Hormone Therapies

A
  • Act to reduce the ability of steroid hormones to activate their receptors
  • Done by reducing hormone production or inhibiting the activation of their receptors with an antagonist
  • Only useful for cancers that are hormonal responsive!
2
Q

Leuprolide/Goserelin

A
  • LHRH agonists
  • Small peptides of gonadotropin releasing hormones that act as GnRH agonists
  • Initially increase FSH and LH followed by suppression d/t desensitization of pituitary GnRH
  • LH/FSH stimulate progesterone/estrogen/testosterone release which can stimulate their prospective cancers
3
Q

Abiraterone Acetate

A
  • Zytiga
  • Inhibits 17alpha-hydroxylase which inhibits steroid hormone production
  • Used to treat advanced hormone-responsive prostate cancer
4
Q

Anastrazole/Letrozole

A
  • Arimidex/Femara
  • Inhibits aromatase which inhibits estrogen production
  • Used to treat metastatic, hormone responsive breast cancer (ER+)
5
Q

SERMs

A
  • Selective Estrogen Receptor Modulators
  • Tamoxifen: requires metabolic activation to endoxifen, tissue dependent, used as ER antagonist in breast cancer
  • Raloxifene: used in breast cancer prevention and for osteoporosis in postmenopausal women
6
Q

Estrogen Receptor Antagonists

A
  • Fulvestrant, Toremifene (in postmenopausal women)

- Used for metastatic breast cancer

7
Q

Megestrol Acetate

A
  • Progestin - decreases estradiol production

- Used in breast, endometrial, and renal cell cancers

8
Q

Androgen Receptor Antagonists

A
  • Enzulatamide - potent androgen receptor antagonist for advanced, castration resistant prostate cancer
  • Bicalutamide - non-steroidal androgen receptor antagonists (used less)
9
Q

Prostate Gland

A
  • Exocrine gland of the male reproductive system
  • Surround urethra just below the bladder
  • BPH, Prostatitis, and prostate cancer are possible pathologies
10
Q

Prostate Cancer Diagnosis

A
  • Staging determines therapy - complex and involved designation (AJCC TNM)
  • TNM designation, PSA level, and Gleason score from biopsy all determine therapy
  • Start with androgen deprivation therapy
  • Can be used as neoadjuvant/adjuvant therapy, for metastatic disease, and can include antiandrogen or LHRH agonists
  • Chemotherapy for castration-resistant prostate cancer
11
Q

SE from ADT

A
  • Impotence
  • Hot flashes
  • Reduced/absent sex drive
  • Breast tenderness
  • Osteoporosis
  • Decreased mental sharpness
  • Loss of muscle mass
  • Weight gain
  • Fatigue
  • Depression
  • Increased cholesterol levels
  • Anemia
12
Q

mCRPC

A
  • Metastatic Castration-Resistant Prostate Cancer
  • Use chemotherapy
  • Docetaxel (increases survival) and Olaparib
  • Supportive therapies: zoledronic acid, alendronate, denosumab
  • Alternatives: Cabazitaxel, Mitoxantrone
  • Radiopharmaceutical options: radium-223 and samarium-153
  • Checkpoint inhibitors: Pembrolizumab (anti-PD1 antibody)
  • Immunotherapies: Sipuleucel-T (vaccine)
13
Q

Sipuleucel-T

A
  • Provenge
  • Autologous dendritic cells are isolated from patient’s blood sample by leukapheresis
  • Cell cultured ex vivo with a fusion protein which enhances immune response
  • Antigen-presenting cells take up these antigens and then reinfused into the same patient to stimulate T-cell response
  • Risk of inappropriate immune activation is low since it’s the patient’s own dendritic cells
14
Q

NSAA Monotherapy

A
  • Not recommended
  • Survival better with androgen deprivation/NSAA combination therapy
  • Survival is small but QoL advantage with NSAA is large
15
Q

LHRH QoL Impact

A
  • Sexual dysfunction
  • Loss of energy/sharpness
  • Increased CVS
16
Q

Other Primary Treatment Options

A
  • Docetaxel (75 mg/m^2) x 6 cycles+ ADT
  • Improves overall survival by ~17 months
  • Usually given with Prednisone 5 mg BIDq
17
Q

When Primary Treatment Stops Working…

A
  • Consider continuing ADT, but controversial (survival vs QoL)
  • Usually recommended to continue indefinitely since most data includes patients on this regimen
18
Q

Asymptomatic/Minimally Symptomatic MCRPC Patients Treatment Options

A
  • Metastatic castrate resistant prostate cancer (MCRPC)
  • Sipeleucel-T
  • Abiraterone 1000 mg/d + Prednisone 10 mg/d
  • Enzalutamide 160 mg/d
19
Q

Symptomatic MCRPC Patients Treatment Options

A
  • Docetaxel
  • RA-223
  • Abiraterone + Prednisone
  • Enzalutamide 160 mg/d
20
Q

Prostate Cancer Supportive Care

A
  • Zoledronic Acid 4 mg IV q3-4 weeks
  • Analgesia: cannabis +/ traditional analgesics
  • Hallucinogens? - may help patients become less anxious/depressed at the end of life by becoming more spiritual/philosophical