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Androgen Deprivation Therapy (ADT): suppression/blockade of testosterone production/action.
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Aromatase Inhibitor (AI): blocks aromatase (CYP19A1) → ↓ estrogen (anastrozole/letrozole/exemestane).
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Selective Estrogen Receptor Modulator (SERM): tamoxifen—ER antagonist in breast, partial agonist in bone/endometrium.
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Selective Estrogen Receptor Degrader (SERD): fulvestrant—binds ER and triggers degradation.
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CYP17A1: androgen-synthesis enzyme targeted by abiraterone.
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Gonadotropin-Releasing Hormone (GnRH): hypothalamic hormone controlling LH/FSH (agonists/antagonists suppress gonadal steroids).
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DiHydroEpiAndrosterone (DHEA): androgen precursor supplement; avoid during endocrine therapy.
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International Prostate Symptom Score (IPSS): urinary symptom scale, 0–35.
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Intrauterine Device (IUD), Copper: non-hormonal contraception of choice during endocrine therapy.
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Osteonecrosis of the Jaw (ONJ): serious antiresorptive complication—avoid implants/extractions on therapy.
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RECIST v1.1: imaging response criteria.
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Dual-Energy X-ray Absorptiometry (DEXA): bone mineral density scan.
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EORTC QLQ-C30, SF-36, FACT-P: validated QoL instruments (oncology general, general health, prostate-specific).
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ESR1/AR-V7: mutations/variants associated with endocrine resistance.
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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Module 2 — Hormone Therapy by Tumor Type (Breast & Prostate)
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Module 3 — Treatment Timing and Duration
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Module 4 — Adverse Reactions and Mitigation
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Module 5 — Integration with Radiotherapy and Systemic Therapy
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Module 6 — Outcomes, Risks & Future Directions
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Module 7 — Appendices & Clinical Tools
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