Hormone therapy in oncology.
Hormone or anti-hormonal therapy is a pill or injection treatment that inhibits hormone production for men and women. Some hormones tend to stimulate the growth of cancer cells in certain types of cancer. This is due to receptors that are expressed on the plasma membrane of cancer cells. Hormone therapy can be used separately or in conjunction with other types of treatment.
For women, treatment with hormone therapy is prescribed for some types of breast, endometrial, or ovarian cancer.
In the case of breast cancer, a biopsy is performed to help determine the types of expressed progesterone and estrogen receptors. If, based on the results of the biopsy, the receptors are expressed, then hormone therapy is prescribed to prevent the risk of relapse or local - distant distribution. If a woman is in the period of menopause, then a separate type of hormonal treatment is prescribed to her. Tamoxifen is an anti-estrogen which is prescribed for a period of 5 years adjuvant the surgery, for women who have not yet had menopause and who have positive hormonal receptors.
An aromatase inhibitor, such as anastrozole or letrozole, is indicated for postmenopausal patients with breast cancer, positive for hormone receptors.
For men, hormone therapy of the first generation is carried out in conjunction with radiotherapy for 6 months if the forecasts are average, and at least 18 months if the forecasts are poor. In the case of metastatic prostate cancer, first-generation hormone therapy is prescribed together with chemotherapy or second-generation hormone therapy (abiraterone acetate, enzalutamide).
For men, LH allows testosterone to be produced in the testis. Therefore, by inhibiting the production of pituitary LH, the overall level of testosterone in the blood drops and no longer stimulates prostate tumor cells. The production of FSH and LH in the pituitary gland depends on pulsating secretion of LH-RH. LH-RH agonists saturate the pituitary receptors, and temporary stimulation will cause the release of LH, thus consequently providing an increase in circulating androgens (“foaming” effect) during the first days. Then the pituitary gland will no longer produce LH and RH due to constant saturation of the receptors, and the concentration of testosterone in the blood will decrease. To combat the increase in transient testosterone levels, antiandrogens are usually prescribed at the beginning of treatment.
LH-RH antagonists will directly block pituitary receptors and quickly cause a drop in LH concentration without the effect of “foaming”. LH-RH agonists are administered every 3 or 6 months in the form of injections: leuprorelin, goserelin, triptorelin. Antagonists LH-RH, Degarelix (Firmagon), monthly injectable form.
For women, hormone therapy can cause side effects, the manifestations of which are similar to the symptoms of menopause: flushing, pain in the joints and muscles, and an increased risk of thrombophlebitis, a slight increase of the risk of endometrial cancer with tamoxifen and weight gain.
For men, hormone therapy causes andropause, impaired libido, decreased sexual ability (erection) and / or leads to weight gain.
LH (hormone lutéinisante)