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Oncology II

Prostate Cancer and Hormonal Therapy

What is the prostate screening recommendations? - for prostate cancer after the age of 50y/r - the frequency depends on the type of screening
what is the survival rate of patients diagnosed with prostate cancer? - pt diagnosed with non- metastatic cancer--> survival rate is high - pt diagnosed with metastatic cancer --> Mortality rate is high
What is the recommended treatment for pt diagnosed with non- metastatic prostate cancer? - surgery - radiation - +/- ADT
What is the recommended treatment for pt diagnosed with metastatic prostate cancer? - depends on castration resistance 1- if NO: ADT + GnRH ( blocker/agonist) 2- If yes: cytotoxic chemo or other hormonal agents
What is the main MOA of hormonal therapies in patient with prostate cancer? - reduce the level of testosterone +/- blocking the receptors
what are some common side effects of using hormonal therapy - ADT drugs? hypogonadism like sxs: 1- hot flashes 2- loss libido 3- gynecomastia 4- hair thin 5- peripheral edema
what are some complications a patient receiving ADT drugs may experience? 1- hyper- lipid 2- DM 3- wt gain 4- osteoporosis 5- metabolic complications 6- QT prolongation ******
What is the MOA of GnRH agonists? - LH hormone releasing hormone agonists ( LHRH ) - suppression of testosterone level via negative feedback MOA
what is the MOA of GnRH induced tumor flare? - LHRH --> Causes initial surge in testosterone level ---> tumor flare in pt with metastatic prostate cancer
what is the recommended prevention of GnRH induced tumor flare? - anti androgens for several weeks in conjunction with the initiation of GnRH agonist
List the common GnRH agonist drugs? - Leuprolide - Goserelin - Histrelin - Triptorelin - Degarelix**
Which GnRH agonists are used to treat women with breast cancer? - leuprolide - goserelin ( leu + gose)
which GnRH agonist doesn't induce tumor flare? Degarelix ( relax no flare)
What are some preventable approaches if GnRH agonist is to be used? - osteoporosis ( vit D and Ca + screening + exercise) - tumor flare ( anti androgen)
when is the use of leuprolide C/I? - vaginal bleeding
when are the use of GnRH agonist C/I? - pregnancy ( All including degarelix) - breastfeeding
what are some common side effects of GnRH agonist? ( low testosterone) - hot flashes - impotence - gynecomastia - peripheral edema - bone pain - QT prolongation - hyper lipid - hyperglycemia -
Which GnRH agonist doesn't cause tumor flare upon initation? Degarelix
what is the main side effect seen with degarelix use?? hypersensitivity rxn-- SC injection/month
what is the common suffix of GnRH agonist? - Relin except leuprolide and degarelix
what us unique about GnRH route of administration? - SC or IM injection ever month for up to 1 yr - SC ONLY for Degarelix
what is the MOA of anti androgen in patient with prostate cancer ? - competitive inhibition of of testosterone binding to prostate cells
Why anti androgen is not used as mono-therapy? - NEVER USE AS MONO-THERAPY ( ineffective) 2/2 up regulation of testosterone receptor - USE WITH GnRH agonist
1st generation anti androgen drugs? - bicalutamide - flutamide - nilutamide
which anti androgen drug causes onest of diarrhea? flutamide
which anti androgen drug cause night blindness ? - niltuamide
which anti androgen drug cause disulfiram reaction? - niltuamide
which anti androgen drug the patient should avoid drinking alchohol while taking it? - niltuamide
which anti androgen drug causes hepatotoxicity? - flutamide
which anti androgen drug causes interstitial pneumonitis? - niltuamide
which 1st generation anti androgen is used most often? bicalutamide
Which anti androgen is C/I if pt is pregnant? bicalutamide
Which anti androgen is C/I in severe hepatic impairment? nilutamide and flutamide
what are some common side effects of using anti androgen drugs? - low testosterone level sxs: 1- hot flashes 2- gynecomastia 3- edema 4- asthenia 5- hepatotoxicity 6- Risk of CV 7- GI: n/v/d
what makes the 2nd generation anti androgen different from the 1st generation? - 1st generation: can't use MONO therapy ( up-regulation of androgen receptor + use with GnRH agonist) vs. - 2nd generation: CAN USE MONO therapy ( no up-regulation of androgen receptor)
what are some common 2nd generation anti androgen? ONE DRUG: Enzalutamide
when is the use of enzalutamide C/I? pregnancy
which anti androgen drug induces/ causes seizure? ( Warning) Enzalutamide
what are some common side effects enzalutamide (2nd generation? - HTN/ edema - hot flashes/ fatigue
what is the MOA of Androgen biosynthesis inhibitor ( Abiraterone)? - inhibits CYP-17 enzyme --> inhibits biosynthesis of steroid in testes and adrenal gland ---> less testosterone production
why steroid should be given in conjunction with Abiraterone in patient with prostate cancer? - Prednisone + abiraterone = negative feedback on aldosterone production - Prevention of HYPER aldosteronism
explain why prednisone is given with abiraterone ( androgen biosynthesis inhibitor)? 1- androgen biosynthesis inhibitor --> inhibits steroid production 2- low steroid --> more aldosterone production --> hyper aldosteronism 3- using prednisone prevents hyper aldosteronism
When is the use of Abiraterone is C/I? pregnancy
what are some common side effects of Abiraterone? - mineralocorticoid excess ( hyper aldosteronism): 1- HTN 2- fluid retention 3- HYPO K 4- HYPO PO4
what are some common side effect of abiraterone? - Hepatotoxicity - HYPER glycemic - increases TG
What is the dosing of abiraterone in patient with prostate cancer? - 1000mg/day ( 4 tablets of 250mg) - GIVEN WITH prednisone 5mg BID to prevent Hyperaldosteronism
when is abiraterone is dose adjusted? concurrent use of CYP 3A4 inducers
what is the appropriate timing of anti androgen drugs to be started in conjunction with GnRH as prevention ( tumor flare) ? - 1 week prior to chemo
Created by: Smoham38



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