All cells respond to signals sent from other cells. One main way that cells use to communicate is hormones. Hormones can be either small proteins (e.g. insulin) or they can be derived from steroids (e.g. estrogen). The signaling cell produces the hormone that is then taken up into the target cell to cause a change in behavior. Hormones can cause a cell to produce new proteins or to stop making products that were already being produced. One possible outcome of hormone signals is the growth and reproduction of the target cells.
Cancer cells, while abnormal, may retain the ability to respond to hormonal signals. The idea behind the majority of hormone-based cancer treatments is to starve the cancer cells of the hormonal signals that would otherwise stimulate them to divide. The drugs used in these treatments work by blocking the activity of the hormone in the target cell. Some newer treatments under investigation are designed to prevent the production of the hormone, cutting off the signal at the start. Some forms of breast, ovarian and prostate cancer are subject to hormonal treatments.
The hormonal treatments described in this chapter are often combined with surgery and/or radiation and/or chemotherapy. In these situations, the hormonal treatments are referred to as an 'adjuvant' treatment.
The hormonal treatments described on the following pages all work by interfering with hormonal signals but they may attack different parts of the pathways involved. The types of hormonal antagonists (and specific drugs) discussed include:
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Selective Estrogen Receptor Modulators (SERMs): These agents work by interfering with the activity of the estrogen receptor. Drugs that work this way include tamoxifen (Nolvadex®), raloxifene (Evista®) and toremifene (Fareston®)
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Aromatase Inhibitors: These drugs work by blocking the production of estrogen by the enzyme that makes it from its precursor. Drugs that work this way include anastrozole (Arimidex®), exemestane (Aromasin®) and letrozole (Femara®).
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Receptor Down-regulators: This class of drugs works by lowering the levels of the receptor for estrogen. Fulvestrant (Faslodex®) is a drug in this category.
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Selective Androgen Receptor Modulators (SARMs): These agents work by interfering with the activity of the androgen receptor. Drugs that work this way include flutamide (Eulexin®) and bicalutamide (Casodex®).
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Other Hormone Treatments: These drugs work to affect the production or activity of hormones in a manner that is not covered in the above categories. The way by which these drugs work may not be entirely clear. An example of this type of drug is megastrol (Megace®).
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Glossary of Hormonal Treatment: An easy to use table of hormonal treatment drugs including trade name, generic name, and type. Contains links to additional information.
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