8.3 Sex hormones and hormone antagonists in malignant disease
8.3 Sex hormones and hormone antagonists in malignant disease
8.3.1 Oestrogens |
AMBER Diethylstilbestrol tablets 1mg |
GREEN Ethinylestradiol tablets 1mg |
8.3.2 Progestogens |
GREEN Medroxyprogesterone acetate tablets 100mg, 400mg |
GREEN Megestrol acetate tablets 160mg |
GREEN Norethisterone tablets 5mg |
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For further information on the uses of Megestrol please see page 39 of guidelines <<link>> |
8.3.4 Hormone antagonists
8.3.4.1 Breast Cancer
AMBER Anastrozole tablets 1mg |
AMBER Exemestane tablets 25mg |
AMBER Letrozole tablets 2.5mg |
AMBER Tamoxifen tablets 10mg, 20mg |
Tamoxifen use in prevention of breast cancer in women with family history of breast |
cancer. [as per NICE guidance] |
AMBER Tamoxifen 10mg.20mg tablets |
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8.3.4.3 Gonadorelin analogues and gonadotrophin-releasing hormone antagonists |
Metastatic cancer of the prostate usually responds to hormone treatments aimed at androgen depletion.
Gonadorelin analogues |
Decapeptyl is the first line, preferential hormone for treatment of high-risk localised or locally advanced prostate cancer, |
as an adjuvant to radical treatments for localised or locally advanced prostate cancer, and for metastatic prostate cancer. |
To be given every 6 months, |
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Goserelin and leuprorelin are recommended for use within their licensed indications. with goserelin recommended as the |
second line product. Any unlicensed uses (e.g. precocious puberty) should not be transferred to primary care prescribers: |
prescribing should be retained by secondary care. There are two shared care protocols in place for the use of goserelin |
(the preferred LHRH analogue). One covers the use in gynaecology, the other covers the use in oncology settings (breast & |
prostate cancer), and they can be accessed online - click here to access them |
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First Line AMBER Decapeptyl 22.5mg SR powder for suspension for injection [Triptorelin®] | For use in the treatment of high-risk localised or locally advanced prostate cancer, as an adjuvant to radical treatments | for localised or locally advanced prostate cancer, and for metastatic prostate cancer. To be given every 6 months. | |
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Second Line |
AMBER with SHARED CARE Goserelin injection 3.6mg, 10.8mg |
Access the shared care guideline here |
AMBER with SHARED CARE Leuprorelin injection 3.75mg, 11.25mg |
(currently no shared care protocols exist for the use of leuprorelin locally as it is a second line agent) |
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Anti-androgens:-
Anti-androgens may inhibit tumour 'flare' which may occur after administration of gonadorelin analogues. |
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AMBER Generic Bicalutamide tablets 50mg, 150mg |
AMBER Cyproterone acetate tablets 50mg, 100mg |
AMBER Flutamide tablets 250mg |
RED Abiraterone Acetate tablets 250mg |
RED Enzalutamide 40mg capsules NICE TAG316 (The use of enzalutamide for treating metastatic hormone- relapsed prostate cancer previously treated with abiraterone is not covered by this guidance) |
RED Enzalutamide 40mg capsules recommended as an option by NICE for treating metastatic hormone relapsed prostate cancer before chemotherapy is indicated. NICE TA377 |
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RED Darolutamide |
NICE TA660 Darolutamide with androgen deprivation therapy [ADT] is recommended, within its marketing authorisation, as |
for treating hormone-relapsed prostate cancer in adults at high risk of developing metastatic disease. |
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RED Apalutamide NHS England Commissioned |
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NICE TA740 Apalutamide plus androgen deprivation therapy (ADT) is recommended, within its marketing authorisation, |
as an option for treating hormone - relapsed non‑metastatic prostate cancer that is at high risk |
of metastasising in adults. High risk is defined as a blood prostate-specific antigen (PSA) level that has |
doubled in 10 months or less on continuous ADT. It is recommended only if the company provides apalutamide |
according to the commercial arrangement. |
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NICE TA741 Apalutamide plus androgen deprivation therapy (ADT) is recommended as an option for treating |
hormone-sensitive metastatic prostate cancer in adults, only if: |
> docetaxel is not suitable |
> the company provides apalutamide according to the commercial arrangement. |
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Gonadotrophin-releasing hormone antagonists |
Degarelix is a gonadotrphin-releasing hormone antagonist used to treat advanced hormone dependent prostate cancer which |
doesnot induce a testosterone surge or tumour 'flare'. Anti-androgen therapy is not required when Degarelix is used. |
CAMET recommends its use ONLY where LHRH analogues or concomittant anti-androgens are contra-indicated. |
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Degarelix is recommended as an option for treating advanced hormone-dependent prostate cancer in people with spinal |
metastases NICE TA404 |
AMBER Degarelix injection with diluent 80mg and 120mg Click here to access a Prescribing Information Sheet for Degarelix (Firmagon®) |
AMBER Relugolix–estradiol–norethisterone acetate [Ryeqo] |
NICE TA832 Recommended, within its marketing authorisation, as an option for treating moderate to severe symptoms of uterine |
fibroids in adults of reproductive age. ICB Commissioned |
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8.3.4.3 Somatostatin analogues
NHS England is responsible commissioner for acromegaly, cancer and congenital |
hyperinsulinism. RED Traffic Light |
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RED Octreotide injection 50 microgram/1ml, 1mg/5ml |
RED Octreotide depot injection 10mg, 20mg, 30mg |
RED Lanreotide 30mg vial |
60mg, 90mg, 120mg prefilled syringes |
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All other licensed indications are considered AMBER Traffic Light. |
AMBER Octreotide injection 50microgram/1ml, 1mg/5ml |
AMBER Octreotide depot injection 10mg, 20mg, 30mg |
AMBER Lanreotide 30mg vial |
60mg, 90mg, 120mg prefilled syringes |
Lanreotide may be prescribed in line with its licensed indications only following |
recommendation from a specialist centre. (NB - Any off license prescribing should not be |
passed on to primary care prescribers) |
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UNLICENSED USE: [Blueteq form required] |
RED Lanreotide [Somatuline Autogel, Somatuline LA®] |
RED Octreotide [Sandostatin, sandostatin LAR®] |
Unlicensed use in non-acute treatment of recurrent gastrointestinal bleeding disorders |
(including angiodysplasia, small bowel dysplasia, gastric antral vascular ectasia, |
haemorrhagic telangiectasia) |
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RED Lanreotide [Somatuline Autogel, Somatuline LA®] |
RED Octreotide [Sandostatin, sandostatin LAR®] |
Unlicensed use in Secretory Gastrointestinal Disorders (e.g. enterocutaneous fistula, high |
output stoma and refractory diarrhoea) |
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