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P A R T 2
Chemotherapeutic agents
TABLE 14.5
DRUGS IN FOCUS Hormones and hormone modulators (continued)
Drug name
Dosage/route
Usual indications
flutamide (Eulexin,
Flutamin)
250 mg PO t.d.s. given 8 hours apart
With a luteinising hormone for treatment of locally
confined and metastatic prostate cancer
Actions:
antioestrogenic drug, inhibits androgen
uptake and binding on target cells
Special considerations:
may cause liver toxicity,
so liver function should be monitored regularly;
associated with impaired fertility and cancer
development; urine may become greenish;
protect person from exposure to the sun—
photosensitivity is common
fulvestrant (Faslodex)
250 mg IM at 1-month intervals
Treatment of hormone receptor–positive
metastatic breast cancer in postmenopausal
women with disease progression after
antioestrogen therapy
Actions:
competitively binds to oestrogen
receptors, downregulating the oestrogen
receptor protein in breast cancer cells
Special considerations:
pregnancy category X;
hot flushes, depression, headache and GI upset
are common; mark calendar with monthly
injection dates; injection-site reactions may
occur
goserelin (Zoladex)
3.6–10.8 mg implant, SC, every 28 days
to 12 weeks, varies with diagnosis
Treatment of advanced prostatic and breast
cancers; management of endometriosis
Actions:
synthetic luteinising hormone that
inhibits pituitary release of gonadotropic
hormones
Special considerations:
a 3.6-mg dose
is effective in decreasing the signs and
symptoms of endometriosis; associated with
hypercalcaemia and bone density loss—monitor
serum calcium levels regularly; impairs fertility
and is carcinogenic; monitor males for possible
ureteral obstruction, especially during the first
month
letrozole (Femara)
2.5 mg/day PO
Treatment of advanced breast cancer in
postmenopausal women with disease after
antioestrogen therapy; postsurgery adjunct for
postmenopausal women with early hormone
receptor–positive breast cancer
Actions:
prevents the conversion of precursors to
oestrogens in all tissues
Special considerations:
GI toxicity, bone marrow
depression, alopecia, hot flushes and CNS
depression are common effects; discontinue
drug at any sign that the cancer is progressing
megestrol (Megace)
160 mg/day PO
Palliative treatment of advanced breast or
endometrial cancer; appetite stimulant for HIV
people
Actions:
blocks luteinising hormone release;
efficacy not understood
Special considerations:
monitor for
thromboembolic events and weight gain; not for
use during pregnancy
