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Course Content
Module 1 — Principles of Hormone Therapy in Oncology
Mechanism and Dosing Overview Aromatase Inhibitors (AIs): block the enzyme aromatase (CYP19A1), which converts androgens to estrogens in adipose and peripheral tissues. Examples: Anastrozole 1 mg orally daily, Letrozole 2.5 mg orally daily, Exemestane 25 mg orally daily. These are the preferred agents in postmenopausal women with estrogen receptor–positive breast cancer. Selective Estrogen Receptor Modulators (SERMs): such as Tamoxifen 20 mg orally daily — bind the estrogen receptor and act as antagonists in breast tissue but partial agonists in bone and endometrium. Selective Estrogen Receptor Degraders (SERDs): such as Fulvestrant 500 mg intramuscularly on days 0, 14, 28, then every 28 days thereafter — promote estrogen receptor degradation. CYP17 Inhibitors: Abiraterone acetate 1000 mg orally daily on an empty stomach plus Prednisone 5 mg orally twice daily — block the CYP17A1 enzyme, suppressing androgen synthesis in adrenal glands and tumors. Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists: Leuprolide 7.5 mg subcutaneously every 4 weeks or depot every 3–6 months; Degarelix 240 mg subcutaneously loading dose, then 80 mg every 4 weeks; Relugolix 120 mg orally daily — suppress testosterone or estrogen production by downregulating or directly blocking pituitary gonadotropin release.
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Lesson 1.1 — Hormone Dependence and Endocrine Manipulation
Lesson 1.2 — Mechanisms, Dosing, and Resistance
Lesson 1.3 — Patient Selection, Toxicity, QoL, Bone & Reproductive Health
Lesson 1.4 — Glossary and Abbreviations
Principles and Mechanisms
Module 2 — Hormone Therapy by Tumor Type (Breast & Prostate)
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Lesson 2.1 — Hormone Therapy in Breast Cancer
Lesson 2.2 — Hormone Therapy in Prostate Cancer
Lesson 2.3 — Integrating Hormone Therapy with Radiotherapy
Lesson 2.4 — Comparative Outcomes & Quality of Life
Breast & Prostate Clinical Scenarios
Module 3 — Treatment Timing and Duration
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Lesson 3.1 — When to Start Hormone Therapy
Lesson 3.2 — When and How to Stop Hormone Therapy
Lesson 3.3 — Managing Treatment Gaps and Restarts
Treatment Timing & Duration
Module 4 — Adverse Reactions and Mitigation
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Lesson 4.1 — Metabolic and Cardiovascular Toxicities
Lesson 4.2 — Bone, Musculoskeletal, and Mineral Disorders
Lesson 4.3 — Sexual, Cognitive, and Emotional Health
Lesson 4.4 — Hepatic, Endocrine, and Rare Adverse Events
Toxicities & Management of Hormone Therapy
Module 5 — Integration with Radiotherapy and Systemic Therapy
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Lesson 5.1 — Rationale for Combining Hormone Therapy with Radiotherapy
Lesson 5.2 — Sequencing with Chemotherapy and Targeted Agents
Lesson 5.3 — Integration with Immunotherapy
Lesson 5.4 — Multimodal Therapy Coordination & Follow-Up
Integration & Sequencing of Hormone Therapy with Radiotherapy and Systemic Therapy
Module 6 — Outcomes, Risks & Future Directions
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Lesson 6.1 — Survival and Disease Control Outcomes
Lesson 6.2 — Quality of Life and Patient-Reported Outcomes
Lesson 6.3 — Economic and Systemic Considerations
Lesson 6.4 — Emerging and Future Directions
Outcomes & Future Directions of Hormone Therapy
Module 7 — Appendices & Clinical Tools
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Lesson A.1 — Drug Dosing Quick Reference Table
Lesson A.2 — Adverse Effect Management Checklist
Lesson A.3 — Quality of Life (QoL) Assessment Toolkit
Hormone Therapy for Cancer Patients: Mechanisms, Indications, and Clinical Practice

When to start: receptor-positive disease with clinical indication (adjuvant, biochemical recurrence, metastatic control) and a plan for duration.
When to stop: radiologic/biochemical progression despite adequate suppression; or severe irreversible toxicity.

Severe irreversible toxicity (CTCAE v5.0 anchors):

  • Grade 3–4 hepatotoxicity (AST/ALT > 5× ULN) unresponsive to dose changes/support.

  • Thromboembolism requiring long-term anticoagulation (e.g., tamoxifen).

  • Fragility fracture on therapy-related bone loss.

  • Persistent severe mood/cognitive impairment impacting daily function.

Bone health (pair with strong anti-estrogen/ADT):

  • Indications for prophylaxis: DEXA T-score ≤ −2.0, or ≥5% annual BMD loss, or FRAX 10-yr risk >20% (major) or >3% (hip).

  • Zoledronic acid: 4 mg IV every 6–12 months (renal-adjust).

  • Denosumab: 60 mg SC every 6 months (no renal adjustment).

  • Supplements: Calcium ~1200 mg/day + Vitamin D 800–1000 IU/day; DEXA every 2 years.

  • Dental precautions (ONJ risk): dental check before first antiresorptive dose; avoid dental implants/extractions during therapy. If unavoidable, consider temporary hold and resume after mucosal healing.

Metabolic & cardiovigilance (especially with ADT/AIs):
Check BP, lipids, fasting glucose periodically; manage lifestyle, statins/metformin as indicated.

Reproductive medicine & contraception:

  • Before therapy: offer fertility preservation (sperm cryopreservation; oocyte/embryo cryopreservation; in some chemo settings, ovarian suppression).

  • Contraception: endocrine agents are teratogenic—use non-hormonal methods, preferably Copper Intrauterine Device (IUD) or barrier methods.

  • Supplements to avoid: DiHydroEpiAndrosterone (DHEA), “testosterone boosters,” phytoestrogens.

  • Tamoxifen washout: stop 2–3 months before attempting conception.

Quality of Life (QoL) tools you can actually use:

  • EORTC QLQ-C30 (oncology general).

  • SF-36 (global health).

  • FACT-P (prostate-specific).

  • International Prostate Symptom Score (IPSS): 0–7 mild, 8–19 moderate, 20–35 severe (track urinary impact during pelvic RT/ADT).

Supportive “crosswalk” (match risk → prevention):

  • Aromatase inhibitors / long-term ADT → osteoporosis → bisphosphonate/denosumab + exercise.

  • Abiraterone → hypertension, hypokalemia, LFT ↑ → prednisone, monitor BP/K+/LFTs.

  • Tamoxifen → thrombosis/endometrial ca → assess VTE risk; evaluate abnormal bleeding.

  • Fulvestrant → injection pain → rotate sites, local measures.

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