disorders . sensation abnormal . skin reactions . sleep
disorders . syncope . vision disorders . vomiting
(DRESS). hypotension . hypoxia . oedema .tachycardia . ulcer. vulvovaginal rash
l ALLERGY AND CROSS-SENSITIVITY Contra-indicated if
history of hypersensitivity to thiol-containing compounds.
l PREGNANCY Not known to be harmful. See also Pregnancy
and reproductive function in Cytotoxic drugs p. 888.
l EFFECT ON LABORATORY TESTS False positive urinary
ketones. False positive or false negative urinary
l DIRECTIONS FOR ADMINISTRATION For oral administration
of the injection, contents of ampoule are taken in a
flavoured drink such as orange juice or cola which may be
stored in a refrigerator for up to 24 hours in a sealed
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral solution
Mesna 100 mg per 1 ml Mesna 1g/10ml solution for injection
ampoules | 15 ampoule P £441.15–£447.15
Mesna 400mg/4ml solution for injection ampoules | 5 ampoule P £17.00 | 15 ampoule P £201.15
Mesna 400 mg Mesna 400mg tablets | 10 tablet P £134.30
Mesna 600 mg Mesna 600mg tablets | 10 tablet P £190.60
VITAMINS AND TRACE ELEMENTS › FOLATES
Prevention of methotrexate-induced adverse effects
▶ BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS
INJECTION, OR BY INTRAVENOUS INFUSION
▶ Adult: 15 mg every 6 hours for 24 hours, to be started
usually 12–24 hours after start of methotrexate
infusion, dose may be continued by mouth, consult
local treatment protocol for further information
Suspected methotrexate overdosage
▶ BY INTRAVENOUS INJECTION, OR BY INTRAVENOUS INFUSION
▶ Adult: Initial dose equal to or exceeding dose of
methotrexate, to be given at a maximum rate of
160 mg/minute, consult poisons information centres
for advice on continuing management
Adjunct to fluorouracil in colorectal cancer
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult: (consult product literature)
As an antidote to methotrexate
▶ BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION
▶ Adult: (consult product literature)
Adjunct to fluorouracil in colorectal cancer
▶ BY INTRAVENOUS INJECTION, OR BY INTRAVENOUS INFUSION
▶ Adult: (consult product literature)
l CONTRA-INDICATIONS Intrathecal injection
l CAUTIONS Avoid simultaneous administration of
methotrexate . not indicated for pernicious anaemia or
other megaloblastic anaemias caused by vitamin B12
l INTERACTIONS → Appendix 1: folates
▶ Rare or very rare Agitation (with high doses). depression
(with high doses). epilepsy exacerbated . gastrointestinal
disorder (with high doses). insomnia (with high doses)
disorders . skin reactions . vomiting
▶ With intramuscular use Urticaria
▶ With intravenous use Sensitisation
▶ With intravenous use Hyperammonaemia
l PREGNANCY Not known to be harmful; benefit outweighs
l BREAST FEEDING Presence in milk unknown but benefit
l NATIONAL FUNDING/ACCESS DECISIONS
▶ Bevacizumab in combination with oxaliplatin and either
fluorouracil plus folinic acid or capecitabine for the treatment
of metastatic colorectal cancer (December 2010) NICE TA212
Bevacizumab in combination with oxaliplatin and either
fluorouracil plus folinic acid or capecitabine is not
recommended for the treatment of metastatic colorectal
www.nice.org.uk/guidance/ta212
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Folinic acid (Non-proprietary)
Folinic acid (as Calcium folinate) 7.5 mg per 1 ml Calcium folinate
15mg/2ml solution for injection ampoules | 5 ampoule P £39.00
DT = £39.00 | 5 ampoule P £39.00 DT = £39.00 (Hospital only)
Folinic acid (as Calcium folinate) 10 mg per 1 ml Calcium folinate
350mg/35ml solution for injection vials | 1 vial P £120.00 | 10 vial P £1,216.80 (Hospital only)
Calcium folinate 50mg/5ml solution for injection vials | 1 vial P £20.00 (Hospital only)
Calcium folinate 300mg/30ml solution for injection vials | 1 vial P £100.00 (Hospital only)
Folinic acid (as Calcium folinate) 3 mg per 1 ml Refolinon
30mg/10ml solution for injection ampoules | 5 ampoule P £23.12
Folinic acid (as Disodium folinate) 50 mg per 1 ml Sodiofolin
400mg/8ml solution for injection vials | 1 vial P £126.25 (Hospital
Sodiofolin 100mg/2ml solution for injection vials | 1 vial P £35.09
BNF 78 Cytotoxic drug-induced side effects 941
Immune system and malignant disease
l DRUG ACTION Levofolinic acid is an isomer of folinic acid.
Prevention of methotrexate-induced adverse effects
▶ BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS
INJECTION, OR BY INTRAVENOUS INFUSION
▶ Adult: Usual dose 7.5 mg every 6 hours for 10 doses,
usually started 12–24 hours after beginning of
Suspected methotrexate overdosage
▶ BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION
▶ Adult: Initial dose at least 50% of the dose of
methotrexate, intravenous infusion to be administered
at a maximum rate of 160 mg/minute, consult poisons
information centres for advice on continuing
Adjunct to fluorouracil in colorectal cancer
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult: (consult product literature)
l CONTRA-INDICATIONS Intrathecal injection
l CAUTIONS Avoid simultaneous administration of
methotrexate . not indicated for pernicious anaemia or
other megaloblastic anaemias caused by vitamin B12
l INTERACTIONS → Appendix 1: folates
▶ Common or very common Dehydration . diarrhoea . mucosal
▶ Rare or very rare Agitation (with high doses). depression
(with high doses). epilepsy exacerbated . gastrointestinal
disorder. insomnia (with high doses). urticaria
l PREGNANCY Not known to be harmful; benefit outweighs
l BREAST FEEDING Presence in milk unknown but benefit
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Levofolinic acid (Non-proprietary)
Levofolinic acid (as Disodium levofolinate) 50 mg per
1 ml Levofolinic acid 50mg/1ml solution for injection vials | 1 vial P £24.70 (Hospital only)
Levofolinic acid 200mg/4ml solution for injection vials | 1 vial P £80.40 (Hospital only)
Levofolinic acid (as Calcium levofolinate) 10 mg per 1 ml Isovorin
175mg/17.5ml solution for injection vials | 1 vial P £81.33
Isovorin 25mg/2.5ml solution for injection vials | 1 vial P £11.62
3.1a Hyperuricaemia associated
Other drugs used for Hyperuricaemia associated with
cytotoxic drugs Allopurinol, p. 1121 . Febuxostat, p. 1121
DETOXIFYING DRUGS › URATE OXIDASES
Prophylaxis and treatment of acute hyperuricaemia,
before and during initiation of chemotherapy, in
patients with haematological malignancy and high
tumour burden at risk of rapid lysis
▶ Adult: 200 micrograms/kg once daily for up to 7 days
according to plasma-uric acid concentration
l CONTRA-INDICATIONS G6PD deficiency
▶ Common or very common Diarrhoea . fever. headache . nausea . skin reactions . vomiting
▶ Uncommon Bronchospasm . haemolysis . haemolytic
anaemia . hypersensitivity . hypotension . methaemoglobinaemia . seizure
▶ Frequency not known Muscle contractions involuntary
l PREGNANCY Manufacturer advises avoid—no information
l BREAST FEEDING Manufacturer advises avoid—no
l MONITORING REQUIREMENTS Monitor closely for
l EFFECT ON LABORATORY TESTS May interfere with test for
uric acid—consult product literature.
l DIRECTIONS FOR ADMINISTRATION For intravenous infusion
(Fasturtec ®), give intermittently in Sodium chloride 0.9%;
reconstitute with solvent provided; gently swirl vial
without shaking to dissolve; dilute requisite dose to 50 mL
with infusion fluid and give over 30 minutes.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Powder and solvent for solution for infusion
Rasburicase 1.5 mg Fasturtec 1.5mg powder and solvent for solution
for infusion vials | 3 vial P £208.39 (Hospital only)
Rasburicase 7.5 mg Fasturtec 7.5mg powder and solvent for solution
for infusion vials | 1 vial P £347.32 (Hospital only)
Breast cancer is the most common form of malignancy in
women, especially in those aged over 50 years. Established
risk factors include age, early onset of menstruation, late
menopause, older age at first completed pregnancy, and a
family history of breast cancer. The use of oral
contraceptives or hormone replacement therapy (HRT) is
also associated with an increased risk of breast cancer.
Breast cancer in men is rare. Although risk factors are not
fully understood, it may be associated with abnormalities of
sex hormone metabolism, including those caused by liver
disease or testicular trauma, genetic predisposition, and
environmental risk factors such as industrial exposure to
Additional risk factors include obesity and alcohol
942 Hormone responsive malignancy BNF 78
Immune system and malignant disease
Physical activity and breast-feeding protect against breast
Non-invasive breast cancer, also known as ductal
carcinoma in situ, is when the cancer remains localised in the
ducts. However, in most cases, the cancer is invasive at the
time of diagnosis, which means that malignant cells are
liable to spread beyond the immediate area of the tumour.
Invasive breast cancer, where malignant cells spread beyond
the ducts, can be defined as early breast cancer (stage I/II),
locally advanced disease (stage III) and advanced disease
of treatment, and are dependent on the stage of the disease.
Surgery and radiotherapy aim to remove the tumour mass,
whilst adjuvant drug therapy (drug treatment following
surgery) aims to reduce the risk of disease recurrence and the
risk of developing invasive disease. Neoadjuvant drug
therapy (drug treatment before surgery) aims to reduce the
size of the tumour to allow breast-conserving surgery to be
possible and to reduce axillary lymph node involvement.
Advanced breast cancer is not curable, and treatment aims to
prolong survival, relieve symptoms and improve quality of
The management of patients with breast cancer involves
surgery, radiotherapy, drug therapy, or a combination of
these. The course of the disease and the therapeutic
approach vary depending on the characteristics of the
cancer. Factors such as patient age, menopausal status,
tumour size and grade, involvement of axillary lymph nodes
or skin, and the presence of hormone receptors within the
tumour, may inform the extent and aggressiveness of the
disease.g The risks and benefits of each therapy should
be discussed with the patient before being started. h
Early and locally advanced breast cancer
For operable breast cancer, treatment involves surgery to the
breast (breast-conserving surgery or mastectomy) and to the
axillary lymph nodes, with or without radiotherapy to reduce
local recurrence rates. This is often followed by adjuvant
drug therapy to eradicate the micro-metastases that cause
relapses.g In women with invasive breast cancer,
radiotherapy is recommended after breast-conserving
surgery with clear margins (no cancer cells are found at the
edges of the removed tissue), as it reduces local recurrence
rates. However, the use of radiotherapy may be omitted if
risk of local recurrence is very low and the woman is willing
to take adjuvant endocrine therapy for a minimum of 5 years.
Radiotherapy is also recommended after mastectomy in
patients with node-positive invasive breast cancer or
involved resection margins (cancer cells are found at the
edges of the removed tissue). It should also be considered in
patients with node-negative T3 or T4 invasive breast cancer.
Adjuvant drug therapy may include the use of
chemotherapy, endocrine therapy, biological therapy, or
bisphosphonate therapy.g The decision to use adjuvant
drug therapy should be based on the risks and benefits of
treatment, disease prognosis and predictive factors such as
oestrogen receptor (ER), progesterone receptor (PR), and
human epidermal growth receptor 2 (HER2) status of the
In women with invasive breast cancer in only one breast
who have not received treatment, including the use of
neoadjuvant chemotherapy, NICE clinical guideline 101
recommends the use of the PREDICT tool to estimate
prognosis and the absolute benefits of adjuvant therapy
g Adjuvant anthracycline–taxane combination
chemotherapy is recommended in patients with invasive
breast cancer who are at sufficient risk of disease recurrence
to require chemotherapy. h The choice of chemotherapy
regimen is usually guided by local policy, Cancer Alliances,
and the National Cancer Drugs Fund list.
g Trastuzumab p. 885 should be offered to patients with
tumour size T1c and above HER2-positive invasive breast
cancer, in combination with surgery, chemotherapy, or
radiotherapy. It should also be considered in patients with a
concomitant chemotherapy. Cardiac function should be
regularly assessed in patients receiving trastuzumab p. 885,
and particular caution should be taken in patients with
underlying cardiac disease (consult product literature for
g Tamoxifen p. 953 should be used as initial adjuvant
endocrine therapy in men and premenopausal women with
oestrogen-receptor-positive invasive breast cancer. In
premenopausal women, taking into account the risk of
temporary menopause. hOvarian function suppression
aims to stop the production of circulating oestrogen, which
can stimulate breast cancer progression. It may be most
beneficial in women who are at sufficient risk of disease
recurrence to have been offered chemotherapy.
g In postmenopausal women with oestrogen-receptor
given as first-line therapy. Alternatively, tamoxifen should
be given if an aromatase inhibitor is not tolerated or is
contra-indicated, or if the risk of disease recurrence is low.
g Extended endocrine therapy (total duration longer than
5 years) with an aromatase inhibitor [unlicensed indication]
should be offered to postmenopausal women with
oestrogen-receptor-positive invasive breast cancer at
medium or high-risk of disease recurrence who have been
taking tamoxifen for 2 to 5 years. Extended therapy should
also be considered in postmenopausal women at low risk of
Extended tamoxifen therapy for longer than 5 years can
also be considered in both premenopausal and
postmenopausal women with oestrogen-receptor-positive
Endocrine therapy for ductal carcinoma in situ
g Following breast-conserving surgery, endocrine
therapy should be offered to women with oestrogen-positive
ductal carcinoma in situ, if radiotherapy is recommended but
not given. If radiotherapy is not recommended, the use of
endocrine therapy should also be considered. h
Zoledronic acid p. 732 and sodium clodronate p. 731 have
been shown to improve disease-free survival and overall
survival in postmenopausal women with node-positive
invasive breast cancer. However, there is insufficient
evidence to recommend their use in premenopausal women.
g Intravenous zoledronic acid [unlicensed indication] or
oral sodium clodronate [unlicensed indication] should be
offered to postmenopausal women with lymph-nodepositive invasive breast cancer. Treatment should be
considered in those with lymph-node-negative invasive
breast cancer who are at high-risk of recurrence. h
BNF 78 Hormone responsive malignancy 943
Immune system and malignant disease
g Bisphosphonate therapy is also recommended in
women at high-risk of osteoporosis due to the use of
aromatase inhibitors in postmenopausal women, or in
women with treatment-induced premature menopause. For
further information, see Guidance for the management of
breast cancer treatment-induced bone loss: a consensus
position statement from a UK expert group, 2008. h
Neoadjuvant drug therapy may involve the use of
chemotherapy or endocrine therapy.
g Neoadjuvant chemotherapy should be offered to reduce
tumour size in patients with oestrogen-receptor-negative
considered. In patients with HER2-positive invasive breast
cancer, neoadjuvant chemotherapy should be offered in
combination with trastuzumab p. 885 and pertuzumab
A chemotherapy regimen containing both a platinum
[unlicensed indication] and an anthracycline should be
considered in patients with triple-negative invasive breast
cancer (oestrogen-receptor-negative, progesterone-receptor
negative and HER2-negative). h
g If chemotherapy is not indicated, neoadjuvant
endocrine therapy should be considered as an alternative in
postmenopausal women with oestrogen-receptor-positive
invasive breast cancer. hChemotherapy and endocrine
therapy are equally effective in postmenopausal women in
terms of breast-conservation and shrinking of the tumour.
Although chemotherapy is more effective than endocrine
therapy at shrinking the tumour in premenopausal women,
some tumours may respond to endocrine treatment.
Treatment of advanced breast cancer depends on the
patient’s treatment history, disease severity, and oestrogen
recommended as first-line treatment. Aromatase inhibitors
should be offered to postmenopausal women with no
previous history of endocrine treatment, or to those
previously treated with tamoxifen p. 953.
Tamoxifen in combination with ovarian function
Ovarian function suppression should be offered to preand perimenopausal women who have had disease
progression despite treatment with tamoxifen.
Tamoxifen should be offered as first-line treatment to
men with oestrogen-receptor-positive advanced breast
g Chemotherapy should be offered as first-line treatment
in patients with oestrogen-receptor-positive advanced
breast cancer that is imminently life-threatening or requires
early relief of symptoms because of significant visceral organ
involvement. Once chemotherapy treatment is completed,
endocrine therapy should be offered. hThe choice of
chemotherapy regimen is usually guided by local policy,
Cancer Alliances, and the National Cancer Drugs Fund list.
g Trastuzumab is recommended for the treatment of
HER2-positive advanced breast cancer. It is used in
combination with paclitaxel p. 925 in those who have not
received chemotherapy for metastatic breast cancer, and as
monotherapy for patients who have received at least two
chemotherapy regimens for metastatic breast cancer (see
trastuzumab National funding/access decisions). h
g The use of bisphosphonates should be considered in
patients with metastatic breast cancer to reduce pain and
prevent skeletal complications of bone metastases. h
g Chemoprevention should be offered to all women who
have been identified as being at high-risk of developing
breast cancer. Chemoprevention should also be considered
in women at moderate-risk. Other strategies to reduce breast
cancer risk should also be considered, for example bilateral
mastectomy or bilateral oophorectomy. Women who were at
high-risk of breast cancer and have undergone a bilateral
mastectomy should not receive chemoprevention. h
Treatment options for chemoprevention
g Chemoprevention should only be continued for 5 years.
Tamoxifen [unlicensed indication] is recommended for
premenopausal women who do not have a history of, or
increased risk of thromboembolic disease or endometrial
Anastrozole p. 954 [unlicensed indication] is
recommended in postmenopausal women who do not have
severe osteoporosis, see Osteoporosis p. 725. In women who
have severe osteoporosis, or who do not wish to take
anastrozole, treatment with tamoxifen can be given,
provided there is no history, or increased risk of
thromboembolic disease or endometrial cancer.
Alternatively, raloxifene hydrochloride p. 754 is an option
[unlicensed indication] in postmenopausal women with a
uterus who do not wish to take tamoxifen, unless there is a
history or increased risk of thromboembolic disease. h
Treatment of menopausal symptoms
g Some treatments used in the management of breast
cancer, such as tamoxifen or ovarian function suppression
may lead to menopausal symptoms or early menopause, and
women should be counselled about these side-effects prior
to starting any of these treatments.
Women diagnosed with breast cancer should discontinue
their hormone replacement therapy (HRT) because of
possible tumour stimulation and interference with adjuvant
endocrine therapy. HRT should not be offered routinely to
women with menopausal symptoms if they have a history of
breast cancer; however, in exceptional circumstances, HRT
can be offered to women with severe menopausal symptoms
once the associated risks have been discussed.
Selective serotonin re-uptake inhibitor (SSRIs)
antidepressants may be offered to relieve menopausal
symptoms such as hot flushes in women with breast cancer
who are not taking tamoxifen. hClonidine hydrochloride
p. 145, venlafaxine p. 368 [unlicensed indication] and
gabapentin p. 315 [unlicensed indication] are sometimes
used for the treatment of hot flushes in women with breast
cancer after discussion with the patient and information
Early and locally advanced breast cancer: diagnosis and
management. National Institute for Health and Care
Excellence. Clinical guideline 101. July 2018.
www.nice.org.uk/guidance/ng101
Advanced breast cancer: diagnosis and treatment.
National Institute for Health and Care Excellence. Clinical
Familial breast cancer: classification, care and managing
breast cancer and related risks in people with a family history
of breast cancer. National Institute for Health and Care
944 Hormone responsive malignancy BNF 78
Immune system and malignant disease
Excellence. Clinical guideline 164. June 2013 (updated March
www.nice.org.uk/guidance/cg164
nos.org.uk/media/98027/bone-health-guidelines-breast-cancertreatments.pdf
Prostate cancer is the most common form of cancer affecting
men. The main risk factors are age (most cases being
diagnosed in men over 65 years of age), ethnicity (more
common in black African-Caribbean men), and a familial
component. Prostate cancer is usually slow-growing and
asymptomatic at diagnosis, however, the presenting
symptoms of advanced disease are usually urinary outflow
obstruction, or, pelvic or back pain due to bone metastases.
Treatment decisions are guided by baseline prostate specific
antigen (PSA) levels, tumour grade (Gleason score), the stage
of the tumour, the patient’s life expectancy (based on age
and comorbid conditions), treatment morbidity, and patient
In early or locally advanced prostate cancer, radical
treatment aims to eliminate the malignancy. In metastatic
disease, drug therapy is aimed at prolonging survival and
Treatment options for patients with prostate cancer include
active monitoring, radical prostatectomy, external beam
radiotherapy, and brachytherapy. Hormone therapy
(androgen deprivation or anti-androgens) is the primary
treatment for metastatic prostate cancer, but is also
increasingly being used for patients with locally advanced,
In patients with localised prostate cancer, the choice of
treatment is guided by whether the disease is considered
low, intermediate, or high risk according to the Gleason
score, the serum PSA level, and the tumour stage.
Localised or locally advanced prostate cancer
g In patients with low-risk localised prostate cancer,
and those at intermediate risk who decline radical
treatments (prostatectomy or radiotherapy), active
monitoring is a suitable option. This involves close
monitoring to avoid unnecessary treatment until disease
progression occurs (or until the patient requests treatment).
In patients with intermediate-risk or high-risk localised
disease, radical prostatectomy or radical radiotherapy
should be offered. Other treatment options include a
combination of radical radiotherapy and androgen
deprivation therapy, consisting of 6 months of androgen
deprivation therapy before, during or after radiotherapy.
Pelvic radiotherapy should be considered in those with
locally advanced prostate cancer who have a higher than
15% risk of pelvic lymph node involvement and are to
receive neoadjuvant hormonal therapy.
Androgen deprivation therapy involves the use of a
luteinising hormone-releasing hormone (LHRH) agonist
(buserelin p. 738, goserelin p. 739, leuprorelin acetate p. 740,
or triptorelin p. 741), or bilateral orchidectomy, which
removes the supply of endogenous hormone. Androgen
deprivation therapy may be continued for up to 3 years in
patients with high-risk localised prostate cancer.
Patients should be informed about the side-effects of
treatment, particularly urinary and sexual dysfunction, loss
of fertility, radiation-induced enteropathy, and hot flushes.
Although there is limited evidence, intermittent therapy
may be considered for patients who are having long-term
androgen deprivation therapy, to reduce drug toxicity.
Tumour flare, due to an initial surge in testosterone
concentrations, has been reported in the initial stages of
treatment with androgen deprivation therapy and
prophylactic anti-androgen therapy (such as cyproterone
Medroxyprogesterone acetate p. 810 [unlicensed
indication] can be used, initially for up to 10 weeks, to
manage troublesome hot flushes caused by long-term
androgen suppression; cyproterone acetate is an alternative
if medroxyprogesterone acetate is not effective or not
Patients who experience a reduction in libido and loss of
sexual function should have access to specialist erectile
dysfunction services and be considered for treatment with a
phosphodiesterase type-5 inhibitor.
Osteoporosis and fatigue may also be a problem with
androgen deprivation therapy. A bisphosphonate can be
offered to men who have osteoporosis; denosumab p. 734 is
an alternative if bisphosphonates are not appropriate.
Gynaecomastia can occur with long-term (longer than
6 months) bicalutamide p. 947 treatment. Prophylactic
radiotherapy (within the first month of treatment), or weekly
tamoxifen p. 953 [unlicensed indication], if radiotherapy is
unsuccessful, can be considered. h
g Bilateral orchidectomy should be offered to all patients
with metastatic prostate cancer as an alternative to
continuous LHRH agonist treatment. Anti-androgen
monotherapy with bicalutamide [unlicensed indication] can
be offered to those who are willing to accept the adverse
impact on overall survival and gynaecomastia in the hope of
retaining sexual function. However, if satisfactory sexual
function is not maintained, stop bicalutamide and start
Abiraterone acetate p. 946 (in combination with
prednisone or prednisolone p. 678) and enzalutamide p. 947
are both recommended as options for the treatment of
castration-resistant metastatic prostate cancer in patients
whose disease has progressed during or after treatment with
a docetaxel p. 924-containing chemotherapy regimen.
In patients who develop hormone-relapsed metastatic
tumour, chemotherapy with docetaxel can be used. It is
recommended to stop the treatment with docetaxel after
10 cycles, or if severe adverse events occurred, or if there is
evidence of disease progression.
Abiraterone acetate (in combination with prednisone or
prednisolone) is also recommended as an option for treating
metastatic hormone-relapsed prostate cancer in patients
who have no or mild symptoms after androgen deprivation
therapy has failed, and before chemotherapy is indicated.
In patients with hormone-relapsed prostate cancer, a
corticosteroid, such as dexamethasone p. 675, can be offered
as third line therapy, after androgen deprivation therapy and
Prostate cancer: diagnosis and treatment. National Institute
for Health and Care Excellence. Clinical guideline 175.
www.nice.org.uk/guidance/cg175
Other drugs used for Hormone responsive malignancy
Ethinylestradiol, p. 759 . Norethisterone, p. 764
BNF 78 Hormone responsive malignancy 945
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