PHAR3922 - Hormonal Cancers

What are the key risk factors for prostate cancer?

Age >50

family hx

African American

Higher insulin-like growth factor-1 and free testosterone

What are the key risk factors for breast cancer?

Age >50

female

BRCA1/2 mutations

family hx

diet/exercise

contraceptive or HRT use

What is the role of BRCA1/2 in breast cancer risk?

They are tumour-suppressor genes

If occurs -> impair DNA repair + increase cancer susceptibility

What are common early symptoms of prostate cancer?

asymptomatic early

What are common advanced symptoms of prostate cancer?

Urinary changes

blood in urine

pain

unexplained weight loss

What are common symptoms of breast cancer?

Breast lump

nipple discharge

breast size/texture changes

redness

swelling

pain

What are the main screening/diagnosis methods for prostate cancer?

PSA test (not cancer-specific)

Gleason grading

ISUP grading

TNM staging

What are the main screening/diagnosis methods for breast cancer?

Clinical exam → mammogram → ultrasound → biopsy → MRI; biopsy allows IHC receptor profiling (ER, PR, HER2)

What is the primary treatment modality for prostate cancer?

Androgen deprivation therapy (ADT), LHRH agonists/ antagonists

anti-androgens

CYP17 inhibitors

What other treatments are available for prostate cancer?

Surgery

radiotherapy (EBRT or brachytherapy)

chemotherapy

immunotherapy

focal therapy

Sx control

What are examples of androgen deprivation strategies (a in prostate cancer?

Surgical castration

LHRH agonists (goserelin)

LHRH antagonists (degarelix)

anti-androgens (bicalutamide)

CYP17 inhibitor (abiraterone + prednisone)

What are examples of hormonal therapies in breast cancer?

SERMs (tamoxifen) -> block ER

SERDs (fulvestrant) -> down-regulate ER

aromatase inhibitors (letrozole) -> post-men in combo with LHRH if pre-men

LHRH analogues (goserelin) -> pre-men in combo with targetted Tx

What are examples of targeted therapies in breast cancer?

mAb -inhibit HER2 signaling (trastuzumab, Pertuzumab)

TK inhibitors of HER2 (lapatinib, neratinib)

PARP inhibitors (Olaparib) for BRCA mutated

TROP2-directed drugs

What are examples of chemotherapy drugs in breast cancer?

alkylating agents

Anthracyclines (doxorubicin)

antimetabolites (methotrexate)

platinums (cisplatin)

taxanes (paclitaxel)

Which therapies cause Type 1 (irreversible) cardiotoxicity?

Anthracyclines ( doxorubicin)

Which therapies cause Type 2 (reversible) cardiotoxicity?

HER2-targeted therapies (trastuzumab)

What are risk factors for anticancer drug-induced cardiotoxicity?

Older age (>60), hypertension, coronary artery disease, prior anthracycline therapy