Hormones

HORMONES

They are not cytotoxic, but modify the growth of hormone-dependent tumours. All hormones are only palliative.

Glucocorticoids

They have marked lympholytic action—are primarily used in acute child hood leukaemia and lymphomas. They induce remission rapidly but relapses inevitably occur after variable intervals and gradually the responsiveness is lost. Considerable palliative effects are obtained in Hodgkin’s disease. Glucocorticoids have a secondary role in some hormone responsive breast cancers.

Corticosteroids are also valuable for the control of complications like hypercalcaemia, haemolysis, bleeding due to thrombocytopenia, increased intracranial tension and mediastinal edema due to radiotherapy. Moreover, they afford symptomatic relief by antipyretic and mood elevating action and potentiate the antiemetic action of ondansetron/metoclopramide. Prednisolone/ dexamethasone are most commonly used; doses are high—hypercorticism may occur (see Ch. No. 20).

Estrogens

They produce symptomatic relief in carcinoma prostate, which is an androgen-dependent tumour. However, relapses occur, but life is prolonged. Estrogens have been superseded in carcinoma prostate by GnRH agonists used with an antiandrogen.

Fosfestrol

It is the phosphate derivative of stilbestrol; has been specifically used in carcinoma prostate. Dose: 600–1200 mg i.v. initially, maintenance 120–240 mg orally. HONVAN 120 mg tab, 300 mg/5 ml inj.

Selective Estrogen Receptor Modulators (Tamoxifen)

Selective Estrogen Receptor Down Regulators (Fulvestrant)

Aromatase Inhibitors (Letrozole, Etc).

The above three classes of drugs are the sheet anchor of adjuvant and palliative therapy of carcinoma breast, as well as for primary and secondary prevention of breast cancer (see Ch. No. 22).

Antiandrogen

Flutamide and bicalutamide antagonise androgen action on prostate carcinoma and have palliative effect in advanced/metastatic cases. Because they increase androgen levels, combination with orchiectomy or GnRH analogues is required to produce full therapeutic effect.

5-α Reductase Inhibitor

Finasteride and dutasteride inhibit conversion of testosterone to dihydrotestosterone in prostate (and other tissues), have palliative effect in advanced carcinoma prostate; occasionally used.

GnRH Agonists

They indirectly inhibit estrogen/androgen secretion by suppressing FSH and LH release from pituitary and have palliative effect in advanced estrogen/androgen dependent carcinoma breast/prostate. They are generally used in combination with antiandrogens or SERMS.

Progestins

They bring about temporary remission in some cases of advanced, recurrent (after surgery/radiotherapy) and metastatic endometrial carcinoma. High doses are needed. They have also been used in palliative treatment of metastatic carcinoma breast that has become unresponsive to tamoxifen.