Endocrine Treatment In Breast Cancer Flashcards
(11 cards)
What is the goal of endocrine therapy in breast cancer?
To block all lower the effect of oestrogen on hormone receptor, positive breast cancer cells slowing or stopping tumour growth
What are the three main classes of endocrine therapies used in breast cancer?
Selective oestrogen receptor modulators (SERM)
aromatase inhibitors
selective oestrogen receptor down regulators (SERD)
Name a commonly used SERM and describe its mechanism
Tamoxifen
it competitively binds to oestrogen receptors blocking oestrogen from stimulating breast cancer cell growth
act as an antagonist in breast tissue can be an agonist and other tissues
In which patients are aromatase inhibitors primarily used and how do they work?
Used in mainly postmenopausal women they inhibit the aromatase enzyme reducing oestrogen synthesis from androgens
Give an example of an aromatase inhibitor
Letrozole
What is a SERD and give an example?
Selective oestrogen receptor down regulator
Fulvestrant is the main example
it binds to and degrades the oestrogen receptor blocking oestrogen signalling
What is the role of ovarian suppression in endocrine therapy?
Used in pre-menopausal women to stop ovarian oestrogen production often combined with tamoxifen or aromatase inhibitors achieved with GNRH analogues
What are common side effects of endocrine therapies?
Hot flashes
joint pain (AI)
bone loss (AI)
increased risk of blood clots (SERM)
What is a major challenge in endocrine therapy for breast cancer?
Development of endocrine resistance often due to mutations in the oestrogen receptor gene ESR1 or activation of alternative growth pathways
How can endocrine therapy be enhanced in advanced HR positive breast cancer?
By combining with CDK 4/6 inhibitors which improve progression free survival
Palbociclib
What other adjuvant therapies are there?
AKT inhibitors - capivasertib
MTOR inhibitors - everolimus
P13K inhibitors - alpelisib
