Adjuvant treatment for premenopausal women with hormone-responsive breast cancer Exemestane

Breast cancer is the most common female cancer, the second most common cause of cancer death in women (after lung cancer), and the primary cause of death in women ages 45 to 55. Following surgery, systemic anticancer treatment may be given to eliminate any microscopic tumor cells that might remain in the body. This type of therapy is called adjuvant therapy, and it is a very important component of breast cancer treatment. Adjuvant systemic therapy significantly decreases the chance that the cancer will return (or recur), and it also improves a woman's chance of surviving her cancer.

— About 50 to 70 percent of breast cancers require the female hormone estrogen (estradiol) to grow, while other breast cancers are able to grow without estrogen. Estrogen-dependent breast cancer cells produce proteins called hormone receptors, which are essential in order for the cell to use estrogen for growth. These hormone receptors can be estrogen receptors (ER), progesterone receptors (PR), or both. If hormone receptors are present within a breast cancer, women are significantly more likely to benefit from treatments that lower estrogen levels or block the actions of estrogen, thus depriving the cancer cells of the material that stimulates their growth. These treatments are referred to as endocrine or hormone therapies, and such tumors are referred to as "hormone responsive".

 — The goal of adjuvant endocrine therapy is to prevent breast cancer cells from receiving stimulation from estrogen. There are several ways in which this can be accomplished, and a woman's menopausal status often determines the type of adjuvant endocrine therapy that is recommended. Choices for endocrine therapy in postmenopausal women with early breast cancer are tamoxifen and a class of drugs called aromatase inhibitors (AIs).
 

Advance Prostate cancer  Flutamide

Advanced prostate cancer results from any combination of lymphatic, blood, or contiguous local spread.  Over the last 20 years, more cases of prostate cancer have been detected in the early stages, when it is confined to the prostate gland. Prostate cancer that is confined within the prostate gland can be effectively treated and is often cured. However, approximately 15 to 20 percent of newly diagnosed prostate cancers are advanced by the time they are detected, meaning that the cancer has spread outside the prostate gland (called locally advanced prostate cancer) and/or involved the lymph nodes or other organs (called metastatic prostate cancer). Cases of advanced prostate cancer can also occur in men who are initially treated for localized disease and whose prostate cancer then recurs (commonly referred to as a relapse).  Manifestations of metastatic and advanced prostate cancer may include anemia, bone marrow suppression, weight loss, pathologic fractures, spinal cord compression, pain, hematuria, ureteral and/or bladder outlet obstruction, urinary retention, chronic renal failure, urinary incontinence, and symptoms related to bony or soft-tissue metastases.

Anorexia   Megestrol acetate

Anorexia, or the lack or loss of appetite that is combined with decreased food intake, is one of the most frequently reported problems for people with cancer. A poor appetite can result from the effects of the cancer itself or from treatments for cancer. It is the most common symptom contributing to poor nutrition in cancer patients. Some evaluators feel that as many as 80% of those with cancer experience changes in appetite. Anorexia can be one of the most challenging symptoms for patients and families. A Anorexia, if not treated and managed, can progress to a more severe condition, known as cancer cachexia. While limited weight loss is sometimes expected during treatment, the benefits seen by managing anorexia include an increased quality of life and a better ability to tolerate treatments.

Cachexia   Megestrol acetate

Cachexia is loss of weight, muscle atrophy, fatigue, weakness and significant loss of appetite (anorexia)  in someone who is not actively trying to lose weight. It can be a sign of various underlying disorders; when a patient presents with cachexia, a doctor will generally consider the possibility of cancer, certain infectious diseases (e.g. tuberculosis, AIDS) and some autoimmune disorders. Cachexia physically weakens patients to a state of immobility stemming from loss of appetite, asthenia, and anemia, and response to standard treatment is usually poor.

Endometrial Cancer  Megestrol acetate

Endometrial cancer (also called uterine cancer) is the fourth most common type of cancer among women and the most common gynecologic cancer. Although endometrial cancer generally occurs in women who have gone through menopause and are 45 years of age or older, 30% of the women with endometrial cancer are younger than 40 years of age. The average age at diagnosis is 60 years old.
The uterus has a thick muscular wall and an inner lining called the endometrium. The endometrium is very sensitive to hormones and it changes daily during the menstrual cycle. The endometrium is designed to provide an ideal environment for the fertilized egg to implant and begin to grow. If pregnancy does not occur, the endometrium is shed causing the menstrual period.
More than 95% of uterine cancers arise in the endometrium. The most common type of uterine cancer is adenocarcinoma. It arises from an abnormal multiplication of endometrial cells (atypical adenomatous hyperplasia) and is made up of mature, specialized cells (well-differentiated). Less commonly, endometrial cancer arises without a preceding hyperplasia and is made up of poorly differentiated cells. The more common of these types are the papillary serous and clear cell carcinomas. Poorly differentiated endometrial cancers are often associated with a less promising prognosis.
Although the exact cause of endometrial cancer is unknown, it is clear that high levels of estrogen, when not balanced by progesterone, can lead to abnormal growth of the endometrium.

Hormone dependent neoplasms Megestrol acetate

Hormone-Dependent Neoplasms are defined as certain tumors that:
1) arise in organs that are normally dependent on specific hormones and
2) are stimulated or caused to regress by manipulation of the endocrine environment.

Tumor Induced Hypercalcaemia  Zoledronic acid

Tumour-induced hypercalcaemia (TIH) can occur with virtually any tumour type but is associated more frequently with lung cancer, breast cancer and multiple myeloma. It affects more than ten percent of all cancer patients and most often occurs in advanced cancer, in patients with or without bone metastases.
TIH occurs when cells known as "osteoclasts" decompose the bone and release excess calcium into the bloodstream.
Because the kidneys cannot process the calcium overload, TIH -- if not treated -- usually leads to severe dehydration and can cause death.   

Skeletal-Related Events  Zoledronic acid

Bone is one of the most common sites of metastatic disease in patients with cancer,
affecting approximately 400,000 patients each year in USA.  Nearly 70% of patients with advanced breast or prostate cancer will experience bone lesions;  50% of these patients will develop a secondary skeletal complication.
Skeletal infiltration is also frequently found in patients with multiple myeloma,  thyroid, kidney, or lung disease. The pathologic penetration of bone by tumor tissue  can lead to numerous skeletal-related events (SREs).  In clinical studies, SREs have prospectively been defined as pathologic bone fractures
(vertebral or nonvertebral), spinal cord compression, surgery to bone, radiation therapy to bone (including the use of radioisotopes), and hypercalcemia of malignancy.
Skeletal-related events include any secondary complication from the presence of bone metastases
and can occur in both osteolytic and osteoblastic lesions. Pain is the most common symptom of bone disease and is thought to be due to increased sensitization of nociceptors, tumor infiltration of nerve channels, and local tissue acidification during the bone resorption process.