Anti-Estrogen

It is recognized that estrogens play a key role in initiating and maintaining breast cancer development in susceptible women. These women should aboid estrogen containing meds. At tx modality is to block the estrogen receptors with oral administration of the agent Tamoxifen (Tamofen, Tamone). This agent inhibits cell division by binding to the intracellular estrogen receptor, with the net effect that DNA synthesis is impaired. Used only in documented estrogen-dependent breast cancer.

Oral manifestations: Dysgeusia; variable effect on oral mucosa

Systemic problems: Blood dyscrasia (leukopenia, thrombocytopenia)

Potential concerns associated with long-term Tamoxifen

Premenopausal pts: Teratogenesis, Ovarian stimulation

Pre- and post-menopausal pts

1.) Antiestrogenic effects: Osteoporosis, Atherosclerosis

2.) Estrogenic effects: Endometrial carcinoma, Thromboembolic disorders,

Hepatocellular carcinoma

3.) Ophthalmic changes

Prostate Cancer Therapy (Hormonal Agents)

Estrogenic agents (studies at USC using these drugs resulted in feminization – not tolerated well by male pts… surprise!): Conjugated estrogens (Premarin); Dietrhylstilbesterol (DES); Ehthinyl estradiol

Antiandrogens (androgen receptor antagonists): Futamine (Eulexin, hepatic injury); Bicalutamide (Casodex, 2-5% incidence of dry mouth, dysphagia, periodontal abscess)

Category: Medical Subject Notes , Pharmacology Notes