Hormonal Agents

The growth of some cancers is hormone-dependent and may be inhibited by surgical removal of gonads, adrenals and/or pituitary. The same effect is increasingly achievable, at less cost to the patient, by administering hormones, or hormone antagonists, of oestrogens, androgens or progestogens and inhibitors of hormone synthesis.

Breast cancer cells may have receptors for oestrogen, progesterone and androgen and hormonal manipulation benefits some 30% of patients with metastatic disease; when a patient's tumour is oestrogen-receptor positive the response is about 60%, and when negative it is only 10%. After treatment of the primary cancer, endocrine therapy with tamoxifen, 20 mg/d, is the adjuvant therapy of choice for postmenopausal women who have disease in the lymph nodes; both the interval before the development of metastases and overall survival are increased. Adjuvant therapy with cytotoxic drugs and/or tamoxifen is recommended for node-negative patients with large tumours or other adverse prognostic factors.

Cytotoxic chemotherapy is more useful in younger women, with tamoxifen, increasingly, as adjuvant therapy. The optimum duration of dosing with tamoxifen is not yet established, but is likely to be for 5 years or more.

For those who do not respond to tamoxifen, second-line therapy includes progestogens, e.g. megestrol or medroxyprogesterone. Should fluid reten

7 Beatson G T 1896 Lancet 2:104,162.

8 Huggins C et al 1941 Cancer Research 1: 293.

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