Which of the following is/are used in hormonal therapy of breast carcinoma?
Correct Answer: All of the above
Description: Ans. d (All of the above) (Ref. Sabiston I8,h / Table 34-17; H-17,h/Table 86-3)Endocrine-Active Agents Used in the Treatment of Breast Cancer ClassCommon examplesClinical use1Selective estrogen receptor modulators (SERMs)QTamoxifen, Raloxifene, ToremifeneAdjuvant therapy for metastatic disease2Aromatase inhibitors (AIs)Anastrozole Letrozole Exemestane Adjuvant therapy for metastatic disease3Pure antiestrogensFulvestrantSecond-line therapy for metastatic disease4LHRH agonistsGoserelin, LeuprolideAdjuvant therapy for metastatic disease5Progestational agentsMegestrolSecond-line agent for metastatic disease6AndrogensFluoxymesteroneThird-line agent for metastatic disease7High-dose estrogensDiethylstilbestrolThird-line agent for metastatic diseaseHORMONAL THERAPY FOR CARCINOMA BREASTIn patients with node-negative cancer, certain groups may suffer higher relapse rates, and the absolute benefits of chemotherapy are greater. Poor prognostic signs follow:1. Tumor size >2 cm2. Poor histologic and nuclear grade3. Absent hormone receptors4. High proliferative fraction (S phase)5. Content of certain oncogenes such as erb-B2 (HER-2/neu)Drug tamoxifen is an estrogen agonist-antagonist and currently the first-line Rx of estrogen-sensitive breast cancer.Educational PointsNew Agents for Ca breast# Trastuzumab (Herceptin) is a humanized murine monoclonal ab raised against the erb-B2 or HER-2 surface receptor.# Agents that specifically target EGFR include erlotinib and gefitinib and the monoclonal antibody cetuximab. These drugs have found most use in non-small cell lung, pancreatic, and colorectal cancer.# Dual inhibitors of both EGFR and HER-2 have been developed and are finding their way into the treatment of breast cancer (e.g., lapatinib, a dual inhibitor of both enzymes).Age GroupLymph Node StatusEndocrine Receptor (ER) StatusTumorRecommendationPremenopausalPositiveAnyAnyMultidrug chemotherapy + tamoxifen if ER-positive + trastuzumab in HER-2/neu positive tumorsPremenopausalNegativeAny>2 cm, or 1-2 cm with other poor prognostic variablesMultidrug chemotherapy + tamoxifen if ER-positive + trastuzumab in HER-2/neu positive tumorsPost-menopausalPositiveNegativeAnyMultidrug chemotherapy + trastuzumab in HER-2/neu positive tumorsPostmenopausalPositivePositiveAnyAromatase inhibitors and tamoxifen with or without chemotherapy + trastuzumab in HER-2/neu positive tumorsPostmenopausalNegativePositive>2 cm, or 1-2 cm with other poor prognostic variablesAromatase inhibitors and tamoxifen + trastuzumab in HER-2/neu positive tumorsPostmenopausal NegativeNegative>2 cm, or 1-2 cm with other poor prognostic variablesConsider multidrug chemotherapy + trastuzumab in HER-2/neu positive tumors.
Category:
Pharmacology
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