Hormonal therapy or management of cancer

Hormonal therapy or  management of cancer

HORMONAL THERAPY
it has been found that up to 15%of tumors may have responsive elements

Some tumors, most notably breast and prostate cancers. originate from tissues whose growth is under hormonal control. The first at­tempts at hormonal therapy were through surgical ablation of the organ producing the hormones of interest, such as oophorectomy for breast cancer. Currently, hormonal manipulation is accomplished by several different modes .
Hormones or hormone­ like agents can be administered to inhibit tumor growth by blocking or antagonizing the naturally occurring substance, such as estrogen antagonist tamoxifen. Other substances that block the synthesis of the natural hormone can be administered as alternatives. Aromatase inhibitors, for example, block the peripheral conversion of endogenous­  androgens to estrogens in postmenopausal women.

Hormonal therapy provides a highly tumor-specific form of ther­apy in sensitive tissues. In breast cancer, estrogen and progesterone receptor status is used to predict the success of hormonal therapy. Recently, several other biologic variables have been found to have an impact on the success of hormonal therapy, and these variables are likely to be incorporated into clinical practice in the near future.

Hormonal Anticancer Agents like as
 
Androgens as

testosterone and fluoxymesterone  in breast cancer
Antiandrogens as

flutamide and finsaterids in prostate cancer

Antiestrogens as

tamoxifen in breast cancer

Estrogens as

diethylstillbestrol in prostate cancer and ethinyl estradiol in breast cancer

Glucocorticoids as

 hydrocortisone in leukaemia and lymphima 

 prednisone in breast cancer

dexamethasone in multiple myeloma

Gonadotropin inhibitors as

leuprolide in prostatic cancer and gosereline acetate in breast cancer

Progestins as

hydroxyprogesterone caproate in endometrial cancer and medroxyprogesterone in breast cancer

Aromatase inhibitors as

aminoglutemthimide in prostatic and breast cancer

Somatostatin analogues as

 neuroendocrine tumors of the gut carcinoid vipomA APUD tumors amine precursor update and decarboxlylation

 

EXAMPLES FOR HORMONAL THERAPY

Prostate tumours

subcapsular orchidectomy bilateral antiandrogens LHRH analogues stilboestrol oestrogen

Breast tumours

tamoxifens :pre and post menopasual women if ER (Estrogen Receptor) negative or PR(Pregstrone Rceptor)positive 

aromatase inhibitors prevent oestrogen production from peripheral fat no effect on ovarian oestrogen so post menopausal only recent evidence of superior survival in advanced disease compared with tamoxifen for 3rd generation aromatase inhibitors eg anastrazole

progestogens now tend to be used 3rd line as aromatase inhibitors are superior

LHRH analogues monthly goserelin in pre menopausal women 3 monthly preparation does not reliably suppress menstruation in all

Thyroid tumours

thyroxine to suppress TSH secretion

liothyronine used


tags:hormonal,cancer,management,therapy