Transcript Annual General Practitioner Study Day 2011

Annual General Practitioner
Study Day 2012
Men’s Health Workshop
Managing side effects of male cancer therapy
Dr Conleth Murphy, Consultant Medical Oncologist
Prostate cancer therapies
• Endocrine therapies
– ADT: Orchiectomy or LHRH analogues
– Anti-androgens: bicalutamide (casodex)
• Chemotherapy
– Docetaxel (Taxotere)
– Cabazitaxel
• Novel therapies
– Abiraterone (Zytiga)
Androgen Deprivation Therapy
Cognitive dysfunction
Hot flashes
Loss of libido
Anaemia
Cardiovascular effects
Worsening of diabetes
Weight gain
Sarcopaenia
Erectile dysfunction
Osteoporosis
Side effects of ADT
• Hot flashes
– Acupuncture1, venlafaxine2, medroxyprogesterone acetate2
(20mg/day), cyproterone2 (androcur), gabapentin.
• Anaemia
– Monitor B12, folate, TIBC. Avoid EPO
• Metabolic syndrome and cardiovascular health
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50% of men on long term ADT have metabolic syndrome.
Monitor BP, lipids and glucose.
Encourage diet and resistance exercise.
Cardiology review for men with pre-existing IHD
1.
Frisk J, Spetz AC, Hjertberg H, Petersson B, Hammar M. Two modes of acupuncture as a treatment for hot flashes in men with
prostate cancer—a prospective multicenter study with long-term follow-up. European Urology. 2009;55(1):156–163
2.
Irani J, Salomon L, Oba R et al. Efficacy of venlafaxine, medroxyprogesterone acetate, and cyproterone acetate for the treatment of
vasomotor hot flushes in men taking gonadotropin-releasing hormone analogues for prostate cancer: a double-blind, randomised
trial, The Lancet Oncology, Volume 11, Issue 2, February 2010, Pages 147-154
Osteoporosis
• Osteoporosis is common
– ~35% of hormone-naïve men with prostate CA
– ~80% after 10 years of ADT
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Baseline DEXA
Repeat at least every 2 years
Weight bearing and resistance exercise
Calcium 1200mg + Vit D 800 u daily
Zoledronic acid 4mg IV yearly
Alendronate 70mg weekly orally
Denosumab 60mg S/C q6/12 reduced fracture risk.
www.nof.org/professionals/clinical-guidelines
http://www.shef.ac.uk/FRAX/tool.jsp?country=1
Chemotherapy
• Up to 10 cycles of docetaxel
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Febrile neutropaenia: reduced with neulasta
Nail changes: cold gloves can help
Neuropathy: dose reduction, pregabalin
Watery eyes: lubricants, steroid eyedrops, intervention for
canal stenosis
– Anaemia: correct deficiencies, consider EPO
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Steroids reduce fluid retention
Please call with any concerns
Continue LHRH analogue throughout Rx
Cabazitaxel: similar but high rates diarrhoea and
neutropaenia
Abiraterone
• Novel oral inhibitor of androgen synthesis
– Improves survival c/w best supportive care
– 4x 250mg tablets daily 2 hrs after food
– Prednisolone 10mg daily
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Oedema
Hypertension
Abnormal LFTs
Hypokalaemia
– Check BP, LFTs, U&E every 2 weeks for 3 months