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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

Indications

  • Localized high-risk (plus RT).

  • Locally advanced / metastatic (M1).

  • Biochemical recurrence with rapid PSA doubling time.
    (NCCN Prostate 2025; ESMO Prostate 2024)

Therapeutic approaches

Category Mechanism Examples (Trade) Typical Dose / Route Notes
Medical castration (GnRH agonist) Down-regulate pituitary GnRH → ↓ LH/FSH → ↓ testosterone Leuprolide (Lucrin®) 7.5 mg IM/SC q4wk or 22.5 mg q3mo Goserelin (Zoladex®) 3.6 mg SC q4wk or 10.8 mg q12wk Triptorelin (Decapeptyl®) 3.75 mg IM q4wk / 11.25 mg q3mo Initial testosterone flare → co-start anti-androgen  
GnRH antagonist Direct blockade → immediate testosterone suppression Degarelix (Firmagon®) 240 mg SC loading → 80 mg q4wk Relugolix (Orgovyx®) 120 mg PO daily No flare; better CV profile  
Anti-androgens Block AR binding/translocation Bicalutamide (Casodex®) 50 mg PO daily Enzalutamide (Xtandi®) 160 mg PO daily Apalutamide (Erleada®) 240 mg PO daily Darolutamide (Nubeqa®) 600 mg PO BID with food Combine with ADT in high-volume M1 disease for OS gain (~30–35%)  
CYP17A1 inhibitor Blocks androgen synthesis Abiraterone (Zytiga®) 1000 mg PO daily + Prednisone 5 mg BID Monitor BP, K+, LFTs; avoid on full stomach (↑ absorption × 10)  

Treatment timing & duration

  • Localized + RT: start 2–3 months before, continue during, and extend 18–36 months after.

  • Metastatic: continuous ADT or intermittent in select cases (QoL preservation if PSA nadir < 0.2 ng/mL).

Monitoring & targets

  • Testosterone < 50 ng/dL (“castrate level”).

  • PSA nadir time and velocity predict outcome.

  • Alkaline phosphatase trend (bone disease).

  • DEXA scan q 2 y.

Toxicity mitigation

  • Bone loss → bisphosphonate / denosumab prophylaxis.

  • Metabolic syndrome → screen lipids, glucose, BP.

  • Sexual dysfunction → counseling, PDE-5 inhibitors.

  • Cognitive changes → exercise + sleep hygiene.

Practical pearls

  • Always pair long-term ADT with bone protection.

  • Relugolix reduces cardiovascular events (~50% less vs leuprolide).

  • Never combine two hormone classes without trial support (↑ toxicity no OS gain).

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