Hormonal therapy individualizing treatment

Most steroid-sensitive cancers express specific cell surface receptors. Prednisone-sensitive lymphomas, estrogen-sensitive breast cancers, and prostatic cancers express specific receptors for corticosteroids, estrogens, and androgens, respectively. It is now possible to assay tumor specimens for steroid receptor content and to identify which individual patients are likely to benefit from hormonal therapy. Measurement of the estrogen receptor (ER) and progesterone receptor (PR) proteins in breast cancer tissue is now standard clinical practice. ER or PR positivity predicts response to hormonal therapy, whereas patients whose tumors are ER-negative generally fail to respond to such treatment. 

Lower doses of hormone therapy than previously used should be considered as standard initial therapy. Clinicians should prescribe hormone therapy at the lowest effective dose for the shortest duration, carefully and individually weighing treatment goals and risks for each woman. 

Hormone-replacement therapy remains the most effective treatment for vasomotor symptoms and vulvovaginal atrophy and should be considered for women experiencing these symptoms. The goals of treatment are to alleviate or reduce menopausal symptoms and to improve the patient s quality of life while minimizing adverse effects of therapy. The appropriate route of administration should be chosen based on individual patient symptoms and should be continued at the lowest dose for the shortest duration consistent with treatment goals for each patient. 

Hormone suppression therapy can be used, for example, to inhibit the adrenogenital syndrome (3). Higher doses are used. The treatment of the adrenogenital syndrome is only partly substitutive and has to be adapted to the individual case, but doses are needed at which various hormonal effects of the glucocorticoids and mineralocorticoids are likely to become troublesome. 

I Adverse Effects. Side effects (see Table 54—6) of carbamazepine may fluctuate daily, paralleling the rise and decline of serum concentrations. The side-effect profile also may follow a circadian rhythm. Neurosensory side effects (e.g., diplopia, blurred vision, nystagmus, ataxia, unsteadiness, dizziness, and headache) are the most common, occurring in 35% to 50% of patients. These side effects are more common during initiation of therapy and may dissipate with continued treatment. Patients have variable threshold concentrations for the occurrence of CNS side effects. If the carbamazepine serum concentration is kept below the individual threshold, the CNS side effects can be minimized. Dosage manipulation, including the use of the controlled- or sustained-release preparations, should be tried before the patient is considered to be intolerant of carbamazepine. Carbamazepine may induce a hyponatremic hyposmolar condition that is similar to the syndrome of inappropriate antidiuretic hormone secretion. The incidence may increase with age. Periodic determinations of serum sodium concentration are recommended, especially in the elderly." ... 

A woman s reproductive life cycle spans nearly four decades. During this time her hormonal status and ability to reproduce vary considerably. The need for hormonal intervention during this time period varies from person to person and, typically, requires highly individualized medication regimens. The remainder of this chapter will focus on hormonal and selected nonhormonal therapies for the treatment and/or management of contraception, endometriosis, infertility, menopause, and breast cancer. 

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