Hormone-sensitive cancer

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A hormone-sensitive cancer, or hormone-dependent cancer, is a type of cancer that is dependent on a hormone for growth and/or survival. Examples include breast cancer, which is dependent on estrogens like estradiol, and prostate cancer, which is dependent on androgens like testosterone.

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Hormones play important roles in our body, they're also effective in some types of cancer by promoting some tumors grow and spread, which are so-called hormone-sensitive or hormone-dependent cancer. A hormone-sensitive cancer, or hormone-dependent cancer, is a type of cancer that is dependent on a hormone for growth and/or survival. If a tumor is hormone-sensitive, it means that there are special proteins called receptors on cells surface. When the hormone bind the matched receptor, it results in growth and spread of cancer cells.

Mechanism of carcinogenesis

While tumor initiating event for hormone-related cancers can be varied, the promotion event and subsequent proliferation is driven by a sex hormone. Both endogenous and exogenous hormones, by driving cell proliferation, increased the number of cell divisions and the opportunity for random genetic errors to lead to cancer. [1]

Hormone-sensitive cancer types

The main types of Hormone-sensitive cancers are the following. [2]

Breast cancer

Breast cancer is often hormone responsive, since growth or regression of tumors can often be regulated by appropriate endocrine manipulations. [3] Estrogen and progesterone seem to be main hormones involved in growth of breast cancer. [3]

Ovarian cancer

Ovarian cancer can be affected by estrogen. β-estradiol (E2) can stimulate the growth of some estrogen receptor(ER)-positive ovarian carcinoma cells, and these effects may be related with changes in the cellular levels of steroid hormone receptors. [4]

Uterine cancer

Uterine or endometrial cancer are activated by estrogen and progesterone are related to this type. The uterine endometrium is extraordinary sensitive to steroid hormones, observation that women who ovulate and produce progesterone have an extremely low possibility to get endometrial cancer proves progesterone as a critical inhibitor of carcinogenesis. [5]

Prostate cancer

Prostate cancer is dependent on androgens like testosterone and similar hormones that can help it grow and spread.

Treatment

Treatments for hormone-sensitive-cancers include blocking the synthesis or action of the hormone or surgery to remove the organ that produces the hormone. [2] Androgen deprivation therapy includes treatment with androgen receptor antagonists and/or surgical removal of the testes while estrogen deprivation therapy involves treatment with estrogen receptor antagonists and/or surgical removal of the ovaries.

Receptor antagonists

Antiandrogens or antiestrogen are used to block the binding of androgen and estrogen to their respective nuclear hormone receptors and thereby blocks the proliferative effects of these hormone on hormone dependent cancer.

For example, the antiestrogen tamoxifen used for the treatment of breast cancer [6] while the antiandrogen bicalutamide alone [7] or in combination with castration [8] is used to treat prostate cancer.

Interruption of hormonal stimulus. For example, tamoxifen can slow the progression until actual hormone independence occurs in the pathway later. In more recent years, evidence in support of this cell proliferation model of hormone responsive cancer etiology has continued to accumulate. Anti-hormone therapies are proved to be effective in stopping progression and thereby increasing the time to recurrence or death. [9]

Receptor agonists

Progesterone is regarded as the major endometrial tumor suppressor, [5]

Synthesis inhibitors

Various agents that block key events in the synthesis of hormones are sometimes used to treat hormone dependent cancers. Aromatase inhibitors such as anastrozole block the synthesis of estrogen while CYP17A1 inhibitors such as abiraterone block the synthesis of androgen. Gonadotropin-releasing hormone antagonists blocks the signaling that stimulates androgen synthesis.

Surgery

As the growth of hormone dependent cancer is driven by sex hormones, surgical removal of the organs that synthesizes the sex hormone is sometimes performed. In the case of prostate cancer, orchiectomy (surgical castration) of the testes is sometimes performed while oophorectomy (surgical removal of the ovaries) is sometimes performed to prevent breast cancer in high risk women with BRCA1 or BRCA2 mutations.

Related Research Articles

Estrogen Primary female sex hormone

Estrogen or oestrogen is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three major endogenous estrogens that have estrogenic hormonal activity: estrone (E1), estradiol (E2), and estriol (E3). Estradiol, an estrane, is the most potent and prevalent. Another estrogen called estetrol (E4) is produced only during pregnancy.

Antiandrogen Class of pharmaceutical drugs

Antiandrogens, also known as androgen antagonists or testosterone blockers, are a class of drugs that prevent androgens like testosterone and dihydrotestosterone (DHT) from mediating their biological effects in the body. They act by blocking the androgen receptor (AR) and/or inhibiting or suppressing androgen production. They can be thought of as the functional opposites of AR agonists, for instance androgens and anabolic steroids (AAS) like testosterone, DHT, and nandrolone and selective androgen receptor modulators (SARMs) like enobosarm. Antiandrogens are one of three types of sex hormone antagonists, the others being antiestrogens and antiprogestogens.

Endometrial cancer Uterine cancer that is located in tissues lining the uterus

Endometrial cancer is a cancer that arises from the endometrium. It is the result of the abnormal growth of cells that have the ability to invade or spread to other parts of the body. The first sign is most often vaginal bleeding not associated with a menstrual period. Other symptoms include pain with urination, pain during sexual intercourse, or pelvic pain. Endometrial cancer occurs most commonly after menopause.

Bicalutamide Prostate cancer treatment

Bicalutamide, sold under the brand name Casodex among others, is an antiandrogen medication that is primarily used to treat prostate cancer. It is typically used together with a gonadotropin-releasing hormone (GnRH) analogue or surgical removal of the testicles to treat advanced prostate cancer. To a lesser extent, it is used for early prostate cancer at a higher dosage as a monotherapy without castration. Bicalutamide is also used to treat excessive hair growth and scalp hair loss in women, as a component of feminizing hormone therapy for transgender women, to treat early puberty in boys, and to prevent overly long-lasting erections in men. It is taken by mouth.

Flutamide Chemical compound

Flutamide, sold under the brand name Eulexin among others, is a nonsteroidal antiandrogen (NSAA) which is used primarily to treat prostate cancer. It is also used in the treatment of androgen-dependent conditions like acne, excessive hair growth, and high androgen levels in women. It is taken by mouth, usually three times per day.

PELP-1

Proline-, glutamic acid- and leucine-rich protein 1 (PELP1) also known as modulator of non-genomic activity of estrogen receptor (MNAR) and transcription factor HMX3 is a protein that in humans is encoded by the PELP1 gene. is a transcriptional corepressor for nuclear receptors such as glucocorticoid receptors and a coactivator for estrogen receptors.

Hormonal therapy in oncology is hormone therapy for cancer and is one of the major modalities of medical oncology, others being cytotoxic chemotherapy and targeted therapy (biotherapeutics). It involves the manipulation of the endocrine system through exogenous or external administration of specific hormones, particularly steroid hormones, or drugs which inhibit the production or activity of such hormones. Because steroid hormones are powerful drivers of gene expression in certain cancer cells, changing the levels or activity of certain hormones can cause certain cancers to cease growing, or even undergo cell death. Surgical removal of endocrine organs, such as orchiectomy and oophorectomy can also be employed as a form of hormonal therapy.

Feminizing hormone therapy, also known as transfeminine hormone therapy, is hormone therapy and sex reassignment therapy to change the secondary sexual characteristics of transgender people from masculine or androgynous to feminine. It is a common type of transgender hormone therapy and is used to treat transgender women and non-binary transfeminine individuals. Some, in particular, intersex people, but also some cisgender people also take this form of therapy, according to their personal needs and preferences.

Antihormone therapy is a type of hormone therapy that suppresses selected hormones or their effects, in contrast with hormone replacement therapy, which encourages hormone activity.

This article is about the discovery and development of antiandrogens, or androgen receptor (AR) antagonists.

Sexual motivation is influenced by hormones such as testosterone, estrogen, progesterone, oxytocin, and vasopressin. In most mammalian species, sex hormones control the ability and motivation to engage in sexual behaviours.

Gynecomastia Endocrine system disorder of human male breast

Gynecomastia is the abnormal non-cancerous enlargement of one or both breasts in males due to the growth of breast tissue as a result of a hormone imbalance between estrogen and androgen. Gynecomastia can cause significant psychological distress or unease.

Estrogen deprivation therapy, also known as endocrine therapy, is a form of hormone therapy that is used in the treatment of breast cancer. Modalities include antiestrogens or estrogen blockers such as selective estrogen receptor modulators (SERMs) like tamoxifen, selective estrogen receptor degraders like fulvestrant, and aromatase inhibitors like anastrozole and ovariectomy.

High-dose estrogen

High-dose estrogen (HDE) is a type of hormone therapy in which high doses of estrogens are given. When given in combination with a high dose of a progestogen, it has been referred to as pseudopregnancy. It is called this because the estrogen and progestogen levels achieved are in the range of the very high levels of these hormones that occur during pregnancy. HDE and pseudopregnancy have been used in medicine for a number of hormone-dependent indications, such as breast cancer, prostate cancer, and endometriosis, among others. Both natural or bioidentical estrogens and synthetic estrogens have been used and both oral and parenteral routes may be used.

Estrogen (medication) Type of medication

An estrogen (E) is a type of medication which is used most commonly in hormonal birth control and menopausal hormone therapy, and as part of feminizing hormone therapy for transgender women. They can also be used in the treatment of hormone-sensitive cancers like breast cancer and prostate cancer and for various other indications. Estrogens are used alone or in combination with progestogens. They are available in a wide variety of formulations and for use by many different routes of administration. Examples of estrogens include bioidentical estradiol, natural conjugated estrogens, synthetic steroidal estrogens like ethinylestradiol, and synthetic nonsteroidal estrogens like diethylstilbestrol. Estrogens are one of three types of sex hormone agonists, the others being androgens/anabolic steroids like testosterone and progestogens like progesterone.

Pharmacology of bicalutamide

The pharmacology of bicalutamide, a nonsteroidal antiandrogen (NSAA), has been well-characterized. In terms of pharmacodynamics, bicalutamide acts as a selective antagonist of the androgen receptor (AR), the biological target of androgens like testosterone and dihydrotestosterone (DHT). It has no capacity to activate the AR. It does not decrease androgen levels and has no other important hormonal activity. The medication has progonadotropic effects due to its AR antagonist activity and can increase androgen, estrogen, and neurosteroid production and levels. This results in a variety of differences of bicalutamide monotherapy compared to surgical and medical castration, such as indirect estrogenic effects and associated benefits like preservation of sexual function and drawbacks like gynecomastia. Bicalutamide can paradoxically stimulate late-stage prostate cancer due to accumulated mutations in the cancer. When used as a monotherapy, bicalutamide can induce breast development in males due to its estrogenic effects. Unlike other kinds of antiandrogens, it may have less adverse effect on the testes and fertility.

ERX-11

ERX-11, also known as ERα coregulator-binding modulator-11, is a novel antiestrogen and experimental hormonal antineoplastic agent which is being researched for the potential treatment of estrogen receptor-positive breast cancer. It is not a competitive antagonist of the estrogen receptor (ER) like conventional antiestrogens such as tamoxifen or fulvestrant; instead of binding to the ligand-binding site of the ER, ERX-11 interacts with a different part of the ERα and blocks protein–protein interactions of the ERα with coregulators that are necessary for the receptor to act and regulate gene expression. It was designed to bind to the coregulator binding region of the ERα and inhibit the ERα/coactivator interaction, although its precise binding site and mode of action have yet to be fully elucidated and understood. Nonetheless, it is clear that ERX-11 binds within the AF-2 domain of the ERα.

The pharmacology of estradiol, an estrogen medication and naturally occurring steroid hormone, concerns its pharmacodynamics, pharmacokinetics, and various routes of administration.

Henri Rochefort (physician) French cancer physician

Henri Rochefort is a French biochemical doctor, born on 20 November 1935 in Paris, who studied the influence of various hormones and their antagonists on breast and ovarian cancers. He is a corresponding member of the French Academy of sciences.

Endocrine therapy is a common treatment for estrogen receptor positive breast cancer. However, resistance to this therapy can develop, leading to relapse and progression of disease. This highlights the need for new strategies to combat this resistance.

References

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