Hormones and hormone modulators for cancer: Nursing pharmacology

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HORMONES & HORMONE MODULATORS for CANCER TREATMENT, PART 1/2
DRUG NAME	hydroxyprogesterone (Duralutin), medroxyprogesterone (Depo-Provera), megestrol (Megace)	tamoxifen (Nolvadex), raloxifene (Evista), toremifene (Fareston)	anastrozole (Arimidex), letrozole (Femara), exemestane (Aromasin)
CLASS	Sex hormones	Selective estrogen receptor modulators (SERMs)	Aromatase inhibitors
MECHANISM of ACTION	Suppress gonadotropin release by the pituitary → block sex hormone production by the gonads	Block estrogen receptors on cancer cells	Reduce estrogen production
INDICATIONS	Breast cancer Prostate cancer Endometrial cancer Brain tumors Renal cancer
ROUTE(S) of ADMINISTRATION	IM and SubQ (hydroxy-progesterone) PO (medroxy-progesterone, megestrol)	PO
SIDE EFFECTS	Weight gain Myalgia, arthralgia, decreased bone mineral density, fractures Decreased libido, gynecomastia, hot flashes, and vaginal discharge, dryness, or irritation Anorexia, nausea, vomiting, diarrhea Increased risk for cardiovascular disease Tamoxifen (boxed warnings): thromboembolic events, stroke, uterine cancers Raloxifene (boxed warnings): thromboembolic events, stroke Toremifene (boxed warning): QT prolongation
CONTRA-INDICATIONS & CAUTIONS	Pregnancy and breastfeeding Hepatic or renal disease

HORMONES & HORMONE MODULATORS for CANCER TREATMENT, PART 2/2
DRUG NAME	flutamide (Eulexin), apalutamide (Erleada), bicalutamide (Casodex, Calutex)	leuprolide (Eligard, Lupron, Viadur), goserelin (Zoladex)
CLASS	Antiandrogens	Gonadotropin-releasing hormone analogs
MECHANISM of ACTION	Block androgen receptors on cancer cells	Reduce gonadotropin release by the pituitary → block sex hormone production by the gonads
INDICATIONS	Breast cancer Prostate cancer Endometrial cancer Brain tumors Renal cancer
ROUTE(S) of ADMINISTRATION	PO	SubQ IM (leuprolide)
SIDE EFFECTS	Weight gain Myalgia, arthralgia, decreased bone mineral density, fractures Decreased libido, gynecomastia, hot flashes, and vaginal discharge, dryness, or irritation Anorexia, nausea, vomiting, diarrhea Increased risk for cardiovascular disease Flutamide (boxed warning): severe hepatotoxicity
CONTRAINDICATIONS & CAUTIONS	Pregnancy and breastfeeding Hepatic or renal disease

NURSING CONSIDERATIONS for
HORMONES & HORMONE MODULATORS for CANCER TREATMENT

ASSESSMENT & MONITORING

Assessment and monitoring: Tamoxifen for ductal carcinoma in situ

Assessment

Vital signs
Laboratory test results: liver and renal function, CBC, calcium, and lipid panel
Diagnostic test results: mammogram, breast ultrasound, MRI, and biopsy results; baseline bone mineral density test

Monitoring

Side effects
Evaluate for the desired therapeutic effect: decreased tumor size, slowed cancer progression

CLIENT EDUCATION

Purpose of medication: help delay tumor growth; decrease the risk of developing invasive breast cancer
Take once daily, with or without food
- Avoid grapefruit juice
Regular follow up for breast, eye, and bone density exams, mammograms, gynecological exams; laboratory tests to monitor lipids and calcium levels
Side effects
- Weight gain
- Hot flashes
- Myalgia
- Vaginal dryness, or irritation
- Temporary increase in tumor size
- Seek immediate medical attention
  - Symptoms of clotting; weakness on one side of the body, problems speaking or breathing, chest pain, coughing up blood, and pain or swelling in the lower extremities
  - Decreased visual acuity, color vision changes
  - Hypercalcemia: muscle weakness, fatigue, nausea, constipation, or bone pain
  - Malignancies: pelvic pain or pressure; abnormal vaginal bleeding; breast soreness or pain

Transcript

Content Reviewers

Antonella Melani, MD,Lisa Miklush, PhD, RNC, CNS,Gabrielle Proper, RN, BScN, MN

Contributors

Antonia Syrnioti, MD,Mary Roberts MSN, RN,Evan Debevec-McKenney,Cassidy Dermott,Talia Ingram, MSMI, CMI

Hormones and hormone modulators are a group of medications that suppress the function of specific hormones, which slows or stops the growth of hormone-dependent cancers, such as breast, endometrial, and prostate cancers. They can also be used to ease the symptoms caused by certain types of cancer, such as brain or renal cancers.

Now, hormones and hormone modulators can be broadly classified as sex hormones; antiestrogens; aromatase inhibitors; antiandrogens; and gonadotropin-releasing hormone analogs.

Now, some commonly used sex hormones include hydroxyprogesterone, which is administered intramuscularly or subcutaneously for advanced uterine adenocarcinoma; as well as medroxyprogesterone, and megestrol, which are taken orally for endometrial or breast cancer. Once administered, these medications work by suppressing the pituitary gland from releasing gonadotropins, so follicle-stimulating hormone or FSH for short, and luteinizing hormone or LH. As a result, gonadotropins aren’t available to stimulate sex hormone production by the gonads, which ultimately delays the growth of sex hormone-dependent tumors.

There are also antiestrogens, which include selective estrogen receptor modulators, or SERMs for short, such as tamoxifen, raloxifene, and fulvestrant. These medications are administered orally, and work by blocking estrogen receptors on cancer cells, which delays the growth of estrogen-dependent tumors.

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Hormones and hormone modulators for cancer: Nursing pharmacology

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