04.-hormonoterapia-cancerelor

7/25/2019 04.-Hormonoterapia-cancerelor

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HORMONOTERAPIA

CANCERELORINSTITUTUL ONCOLOGIC BUCURESTI

UMF CAROL DAVILADEPARTAMENT ONCOLOGIE-

RADIOTERAPIE


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Defnitie

Hormonoterapia (manipularea hormonala) reprezint !et"#ter#pe$ti%# $ti&iz#t# in n%&'i# !e"i%# in tr#t#!ent$& t$!ri&r(r!n"epen"ente prin )$pri!#re# )$r)e&r "e (r!ni )#$ prin*&%#re# #%+i$nii #%e)tr# ni,e&$& %e&$&ei t$!r#&e

A%e)t tip "e ter#pie )e prete#z# pentr$ #%e&e t$!ri # %#rr %re)teree)te )ti!$t# "e (r!ni .(r!n-"epen"ente/0 pre%$! %#n%ere&e!#!#re0 pr)t#ti%e0 en"!etri#&e0 ne$ren"%rine 1i tiri"iene

Ce&$&e&e t$!r#&e (r!n"epen"ente e3pri!# pe )$pr#4#t# &rre%eptri (r!n#&i "e %#re )e 53e#z# (r!nii %$ #5nit#te pentr$#%e)ti# "e%n)#n" $n )e!n#& intr#%e&$r %e %ntr&e#z# %re)tere# )i

pr&i4er#re# %e&$r# S$nt %e&$&e %#re )$nt in6$ent#te in %re)tere# &r"e (r!ni D#%# %e&$ !#&i'n# %ntine #)t4e& "e re%eptri e)te re)pn)i,#

!#nip$re# (r!n# )i p#te 5 *&%#t# prin in(i*#re# pr&i4er#rii)#$ prin in"$%ere# #pptzei in $r!# pri,#rii "e (r!ni


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Prezent# re%eptri&r (r!n#&i e3pri!#ti pe )$pr#4#t# $nei %e&$&e!#&i'ne reprezint# #t#t 4#%tr "e pr'n)ti% %#t )i 4#%tr pre"i%ti,

Cei !#i %$n)%$+i )$nt re%eptrii %#re &e#' #n"r'enii .%#n%er$& "epr)t#t#/0 e)tr'enii 1i pr'e)tern$& .%#n%er$& !#!#r )i "e en"!etr$/

Scopul hormonoterapiei e)te in(i*#re# #%+i$nii (r!ni&r i!p&i%#+i

7n pr&i4er#re# %e&$r )#$ *&%#re# &e'#rii (r!ni&r "e re%eptr$&%e&$r )i in %n)e%int# *&%#re# !$&tip&i%#rii )i "eter!in#re# #pptzei%e&$&e&r !#&i'ne

Cancerele hormono-sensibile:

C#n%er !#!#r C#n%er "e pr)t#t0 C#n%er "e en"!etr$ C#n%er$& tiri"i#n T$!ri ne$ren"%rine Men! !#&i'n


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CRH8LHRH

ACTH

FSH8LHe)tr#"i&

pr'e)tern

An"r)ten"ine #n"r)ten"ineDHEA te)t)tern

Te)t)tern

(ipt#!$)

(ip5z#

CSR

te)ti%$&

,#r

Ce&$t$!r#

Hr!nter#pi# )$pre)i,#Hr!nter#pi# %!petiti,#


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C)i5%#re# (r!nterpiei

Hr!nter#pi# )$pre)i,# Hr!nter#pi# %!petiti,#

Hr!nterpi# "e )$*)tit$tie


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HORMONOTERAPIA SUPRESIVA

%(ir$r'ie-i)tri% .r(ie%t!ie0 ,#re%t!ie- in%# "in )e%&$& 9I9-

Be#t)n/ r#"iter#pie .DT-:;-:< G= in > 4r#%ti$ni/A,#nt#?e-in)t#re r#pi"# # #4e%t$&$i 4#r# 4en!en$& "e 6#re $p t$!r#&0

%)t )%#z$tDez#,#nt#?e-%!p&i%#tii p)t%(ir$r'i%#&e0 p)tr#"i%e0 ire,er)i*i&it#te !e"i%#!ent#)# .%#)tr#re %(i!i%#/ @)t#n"#r" #%t$#&Analogi GnRH ."e%#pepti" %$ r& "e )e!n#& )e%ret#t "e ne$rnii

(ipt#!i%i %#re in6$ente#z# )e%reti# "e LH8FSH )i in %n)e%int#)e%reti# "e (r!ni )e3$#&i/-%#n%er !#!#r in pre!enp#$z#0 pr)t#t#

Inhibitori ai CSR si enzimelor producatoare de steroizi

-in(i*itri "e #r!#t#z# @ enzi!# i!p&i%#t# in )intez# (r!ni&r

e)tr'eni @%#t#&ize#z# tr#n)4r!#re# te)t)tern$&$i in e)tr#"i&-%#n%er!#!#r in p)t!enp#$z#0-A*ir#terne #%et#t e)te $n in(i*itr p$terni% #& %it%r!$&$i )teri"#&

P


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Inhibitori ai funciei hipozare !i gonadice (analogi "H-RH# Gn-RH)

An#&'ii Gn-RH "eter!in 4r! "e %#)tr#re %(i!i%0 %e p#te5 re,er)i*i& "#% )e #p&i% peri#" &i!it#t "e ti!pA%e1ti# "eter!in 4#z ini+i#& "e )ti!$re .4en!en$& "e$are up/ %e %n)t 7n e3#%er*#re# )i!pt!e&r *&ii %ei %$*#& pr)t#ti% "i)e!in#t0 !#ni4e)t#t prin %re1tere# "$reri&r

)#)e .:-> "in %#z$ri0 %e "$re#z :-; )pt!ni/0 $&terirpr"$%n"$-)e in(i*i+i# 1i )$pre)i# )en)i*i&it+ii (ip5zeiS%"ere# ni,e&$&$i te)t)tern$&$i 1i e)tr'eni&r e)te#)e!nt#re %$ %e# *+in$t prin %#)tr#reIn"i%#+ii&e #n#&'i&r Gn-RH )$nt %#n%ere&e "e pr)t#t

#,#n)#te0 %#n%ere&e !#!#re #,#n)#te 4e!ei&e 7npre!enp#$z An#&'ii LH-RH "i)pni*i&i )$nt &euprolidacetatul .&e$pr&i"e/0 'oserelin acetat .%olade&/0 'userelinul0riptorelina


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Inhibitori ai suprarenalei si ai enzimelor producatoare de steroizi

In(i*itrii "e #r!#t#z# An"r'enii %ir%$n+i )e%ret#+i "e )$pr#ren#& )$nt %n,erti+i 7n

e)tr'eni )$* #%+i$ne# enzi!ei aromataza0 %e )e ')e1te n$ n$!#i 7n)$pr#ren#&e0 %i 1i 7n #&te +e)$t$ri0 pre%$! ,#re0 'n" !#!#r0!$1%(i0 +e)$t #"ip) In(i*itrii "e #r!#t#z "eter!in )$pr#ren#&e%t!ie %(i!i% 1i0 7n #%ei ti!p0 *&%#re# #r!#t#zei )i in%n)e%int# 4r!#re# e)tr'eni&r

a) Inhibitorii nesteroidieni de generaia I .Aminoglutetimid/

*&%(e#z %n,er)i# %&e)ter&$&$i 7n "e&t#--pre'nen&n prin in(i*i+i#%!petiti, # %it%r!$&$i P


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b) Inhibitorii steroidieni de generaia II .ormesatan/ 1i degeneraia III .*&emestan/ "eter!in %# e4e%te )e%$n"#re r#)(%$t#n#t0 )!n&en+0 #!e+e&i0 #t#3ie0 &e$%penie0 4e*r

In(i*itrii "e #r!#t#z . IA/ "e 'ener#+i# # III-# #$ 4)t #pr*#+i %#tr#t#!ent "e pri!# &inie p#%iente&e %$ %#n%ere !#!#re

!et#)t#ti%e0 7n p)t!enp$#z0 4#r# %riz# ,i)%er# M#i !$&te )t$"iir#n"!iz#te !#ri #$ "e!n)tr#t % IA )$nt e5%#%e 7n tr#t#!ent$&%#n%ere&r !#!#re !et#)t#ti%e0 %$ RE pziti,i

A*ir#terne #%et#t e)te $n in(i*itr p$terni% #& %it%r!$&$i )teri"#& P


10/31

-HORMONOTERAPIA OMPETITIVA

Hr!nter#pi# %!petiti, )e re#&ize#z %$ #'enti %#re #$ #5nit#te %re)%$t pentr$ re%eptrii (r!n#&i 1i )e

)$*)tit$ie (r!ni&r re)pe%ti,i0 "eter!inn" in(i*i+i#(r!ni&r trpi (ip5z#ri %re)p$nztri A+ ,odulatorii selectii ai receptorilor estrogenici

( antiestrogenii)

Antie)tr'enii .tamo&ifen# toremifen# ralo&ifen# fulestrant/

)$nt )$*)t#n+e %e pt in(i*# pr&i4er#re# %e&$r printr-,#riet#te "e !e%#ni)!e *&%(e#z %re1tere# t$!r#&!e"i#t prin re%eptrii e)tr'eni0 *&%(e#z %re1tere#!e"i#t prin 4#%trii "e %re1tere t$!r#&i .#nti#n'i'eneti%i1i #pptzi%i/ Pn re%ent0 !"$tr$& )e&e%ti, #i RE %e&

!#i $ti&iz#t in %#n%er$& !#!#r in pre )i p)t !enp#$z#e)te ta!o"i#en E4e%te&e )e%$n"#re *$4e$ri0 're+$ri0 ,r)t$ri .4en!en$&

"e K$are up.7n pri!e&e ; )pt!ni "e #"!ini)tr#re/0!etrr#'ii0 tr!*%itpenie0 e"e!e0 (iperpzi# "een"!etr$0 %#n%er "e en"!etr$0 tr!*e!*&ii

F$&,e)tr#nt-in(i*itr e)tr'eni% p$r %#re *&%(e#z# %!p&et


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'+ Antiandrogenii

Uti&iz#+i 7n tr#t#!ent$& %#r%in!$&$i "e pr)t#t !et#)t#z#t S$nt7!pr+i+i 7n "$ !#ri %#te'rii steroidieni 1i nesteroidieni .p$ri/

a$Antiandrogenii steroidieni )$nt *i1n$it %!p$1i %e e3er%ite4e%te "$#&e "e *&%#re # re%eptr$&$i %it)&i% "e #n"r'en 1i

"e )$pre)ie # pr"$%+iei "e 'n#"tr5ne b$Antiandrogenii nesteroidineni )#$ /puri. n$ )$pri!

'n#"tr5ne&e 1i te)t)tern$&0 "#r )$nt p$terni%i in(i*itri #i#t#1rii n$%&e#re # #n"r'eni&r

E4e%te&e )e%$n"#re )$nt !ini!e 'ine%!#)tie0 "i#ree0 t3i%it#te

(ep#ti% re,er)i*i& Anti#n"r'enii ne)teri"ieni "i)pni*i&i )$nt lutamid0

'icalutamid0 Casode&0 i#r %ei )teri"ieni )$nt reprezent#+i "eCiproteron acetat .Androcur/


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C+0rogestinele

Pr'e)tine&e e3er%it #%+i$ne in"ire%t #)$pr# #3$&$i (ipt#!-(ip5z#r .%e %n)t 7n in(i*#re# pr(r!ni&r 'n#"tr5ni%i(ip5z#ri/ 1i #%+i$ne "ire%t ."e in(i*#re # pr&i4errii %e&$re/

Pr'e)tine&e0 7n p#rti%$r ,egestrol acetatul0 #$ "e!n)tr#t

#%ti,it#te i!prt#nt 7n tr#t#!ent$& %#n%ere&r !#!#re .&inii&e # II-# 1i# III-# "e tr#t#!ent/ 1i %#r%in#!e&r en"!etri#&e 1i #$ "e #)e!ene#$ne&e rez$&t#te 7n %#n%ere&e ,#riene 1i pr)t#ti%e

A$ 4)t $ti&iz#te 1i 7n tr#t#!ent$& %#n%ere&r ren#&e !et#)t#ti%e0 "#r %$r#te !"e)te "e r)p$n) .:/ne%n5r!#te "e )t$"ii&e !"ernePr'e)tine&e "eter!in %re1tere # #petit$&$i 1i %1ti' pn"er#&0 !ti,

pentr$ %#re )$nt $ti&iz#te 1i 7n ter#pi# )i!pt!#ti% E4e%te )e%$n"#re - 4e!iniz#re# .!#i p$+in %# 1*S/0 *ezit#te# 1i $ne&e

e4e%te %#r"i,#)%$re Prep#r#te&e $z$#&e )$nt Me"r3ipr'e)tern#%et#t.arlutal0 0roera/ 1i Me'e)tr& #%et#t .,egace/


13/31

1+ *strogeniiE)tr'enii 4&)i+i 7n tr#t#!ent$& %#n%ere&r "e pr)t#t# !et#)t#z#teUti&iz#re# #%e)tr# e)te re)trn) "#trit e4e%te&r )e%$n"#re%#r"i,#)%$re Prep#r#te&e e)tr'eni%e $ti&iz#te 7n %#n%ere&e "e pr)t#t#)$nt 1ietilstilbestrol .1*S/0 *stradiol0 (estradurin)Clorotrianisen (ace)0E)tr#!$)tin (*strac2t)

*+AndrogeniiMe%#ni)!$& prin %#re "ze&e %re)%$te "e #n"r'eni in(i* %#n%er$& !#!#re)te ne%$n)%$t0 "e1i ",ezi&e e3peri!ent#&e 1i %&ini%e e,i"en+i#z in(i*i+i#(r!ni&r 'n#"tr5ni%i (ip5z#ri 1i pr"$%+i# %re)%$t "e e)tr'eniAn"r'enii *&%(e#z re%eptrii e)tr'eni%i %n%entr#+ii "e : ri !#i%re)%$te "e%t e)tr'enii An"r'enii )$nt $ti&iz#+i #)tzi e3%ep+in#& 7n

tr#t#!ent$& %#n%ere&r !#!#re0 "#trit e4e%te&r )e%$n"#re .,iri&iz#re0(ep#tt3i%it#te0 (iper%#&%e!ie0 tr!*e!*&ii/ 1i rez$&t#te&r !"e)te Une4e%t 4#,r#*i& e)te %e& #n#*&iz#nt Prep#r#te&e "i)pni*i&e )$nt testosteronpropionat .estosterone/0 !etiltestosterone .3reton/ 1i 4luo&imestron.Halotestin/


14/31

HORMONOTERAPIA DE SU%STITUTIE

Hormonii tiroidieni )$nt $ti&iz#ti in %#r%in!$& tiri"i#n "$p tiri"e%t!ie %$)%p$& "e # in(i*# )e%re+i# (ip5z#r "e TSH .%#re reprezint $n 4#%tr "e%re1tere pentr$ %#r%in#!e&e tiri"iene/ 1i tt"#t 7n )%p )$*)tit$ti,Analogii de somatostatin . octreotid# lanreotid# pasitreotid/ )$nt $ti&iz#+i 7ntr#t#!ent$& t$!ri&r %#r%ini"e0 %$ r& "e # in(i*# )e%reti# $nr (r!nipr"$)i "e %e&$ t$!r# .'#)trin#0 %&e%i)t%(inin#0 '&$%#'n0 STH0in)$&in#0 )e%retin#0 VIP/ @ re)pn)#*i&i "e )i!pt!e&e )"r-$&$i %#r%ini"An#&'ii "e )!#t)t#tin )$nt $ti&iz#+i pe *#z# i"enti5%rii re%eptri&r pentr$)!#t)t#tin 7n - "intre t$!ri&e ne$ren"%rine

n 'ener#&0 #n#&'ii "e )!#t)t#tin "eter!in #!e&ir#re# )i!pt!#ti%."i#ree0 $ush/ J "intre p#%ien+i0 1i re"$%ere# %$ # )e%re+iei $rin#re"e -HIAA -J "intre p#%ien+iCe& !#i e5%#%e #'ent e)te $n #n#&' "e )!#t)t#tin n$!it %treti" %$ r&in #!e&ir#re# )i!pt!e&r "#r )i in in(i*iti# pr&i4er#rii t$!r#&eO%treti" e)te "i)pni*i& 7n "$ 4r!e %$ e&i*er#re r#pi" . O%treti" #%et#t-

S#n")t#tin 1i L#nreti"e 1i 4pr!e&e %$ e&i*er#re &ent O%trti" LAR . Ln'#%tin' repet#*&e/0 "i)pni*i& 7n > "ze "e :0 ; 1i >!'S3,456 e)te $n n$ #n#&' "e )!#t)t#tin 7n %$r) "e te)t#re %&ini%prezint $n ti!p "e 7n?$!t+ire pre&$n'it .Q ;


15/31

Corticoterapia

Prezint in"i%#+ii !$&tip&e 7n n%&'ie0 pre%$!

- 7n &e$%e!ii 1i &i!4#!e intr 7n #&%t$ire# )%(e!e&r "etr#t#!ente %it)t#ti%e .e4e%te &i!4&iti%e/ 7n tr#t#!ent$& p#&i#ti,#& )in"r#!e&r 4e*ri&e p#r#nepzi%e

- !et#)t#ze %ere*r#&e 1i )in"r! "e %!pre)i$ne "e ,en %#,)$peri#r

- e4e%t #ntie!eti% )#$ "e pten+#re # !e"i%#+iei #ntie!eti%e- 7n tr#t#!ente&e "e )$)+inere

Hormonoterapia metabolic7

-Pr'e)t#ti,e&e 1i %rti%izii 7n "ze !i%i pt in6$en+# 4#,r#*i&

#nre3i# 1i %#1e3i# p#%ien+ii nepzi%i 7n 4#ze&e ter!in#&e -Meti&te)t)tern$& .#n"r'en )inteti%/ 7n "ze re"$)e

"eter!in e4e%te )!#ti%e 4#,r#*i&e p#%ien+ii "e )e3!#)%$&in0 4r %ntr#in"i%#+ii n%&'i%e )#$ $r&'i%e


16/31

&asa Re're(entanti Meanis! deati*ne

T*!ora tinta Reatii ad+erse

In(i*itri GnRH G)ere&in0Le$pr&in0Triptre&in

B&%#re# )intezei(ip5z#re "eLH8FSH

M#!#rPr)t#t#

S%#"ere#&i*i"$&$i0 Di#ree0Gine%!#)tie0A!enreeB$4e$ri

In(i*itri "e#r!#t#z#

An#)trz&0Letrz&0E3e!e)t#n

B&%#re#%n,er)iei#n"r'eni&r ine)tr'eni

M#!#rO,#ri#n

O)teprz#D$reri #rti%$reB$4e$ri

Antie)tr'eni T#!3i4enR#&3i4enF$&,e)tr#nt

B&%#re#re%eptri&re)tr'eni%i

M#!#rO,#ri#n

C#n%eren"!etri#&0Tr!*e!*&ie0

Hiper&ipe!ie0A)tenie0 Ce4#&ee

Pr'e)t#ti,e Me"r3ipr'e)ternMe'e)tr&

B&%#re# "ire%t# #)intezei "e(r!ni )e3$#&iB&%#re# in"ire%t## )intezei "eLH8RH

M#!#rEn"!etri#&An#*&iz#nti

Gret$ri0 Cr#!pe0Cre)tere in're$t#te0Tr#n)pir#tii

Anti#n"r'eni F&$t#!i"#%iprtern*i%#&$t#!i"#

B&%#re#re%eptri&r#n"r'eni%i

Pr)t#t# S%#"ere# &i*i"$&$iI!ptent#A4e%t#re (ep#ti%#

Crti%izi Pre"ni)n"e3#!et#zn#

Citt3i%Antiin6#!#trRe"$% e"e!$&perit$!r#&

Antie!ez#He!p#tii !#&i'neTr#t#!ent #nt#&'i%

HTA0 U&%er0O)teprz#0 S"rC$)(in'


17/31

HORMONOTERAPIA IN CANCERULMAMAR


18/31

Hr!nter#pi# in %#n%er$&!#!#r

#r!#t#z# An"r'eni E)tr'eni

Re%eptri e)tr'eni%i

Pr&i4er#re t$!r#

#n#)trz&

e3e!e)t#n

&etrz&

t#!3i4en

4$&,e)tr#nt


19/31

CRH8LHRH #n#&'i GnRH

ACTH

FSH8LHe)tr#"i&

pr'e)tern

An"r)ten"ineDHEA

#r!#t#z#

Te)t)tern e)tr#"i&

(ipt#!$)

(ip5z#

CSR,#r

Ce&$t$!r#

Hr!nter#pi# )$pre)i,#


20/31

C&e)ter& pre'nen&n :JOHpre'nen&n

pr'e)tern DHEA"i(i"rte)t)tern

:J OH pr'e)tern #n"r)tene"in#te)t)tern

#r!#t#z##r!#t#z#

:: "e3i%rti)& estroneestradio&

%rti)& estrio&


21/31

Ter#pi# #ntie)tr'eni%# in %#n%er$&!#!#r

Meanis! deati*ne

E"e!'&e

SERM In(i*#re# re%eptri&r"e e)tr'en

t#!3i4en0 r#&3i4en

In(i*itri "e#r!#t#z#

In(i*#re# )intezei "ee)tr'en

#n#)trz&0 &etrz&0e3e!e)t#n

SERD In(i*#re# )i )%#"ere#n$!#r$&$ire%eptri&r "ee)tr'en

4$&,e)tr#nt

S$pre)i# ,#ri#n# B&%#re# pr"$%erii"e e)tr'en ni,e&,#ri#n In(i*itiepit$it#r#

O,#re%t!ie0r#"iter#pi#

An#&'i LHRH


22/31

In(i*itrii "e #r!#t#z#

%&e)ter&

#&")tern %rti)& #n"r)tene"in#

e)trn# te)t)tern

e)tr#"i&in(i*itri nn)e&e%ti,i

in(i*itri )e&e%ti,i


23/31

In(i*itrii "e #r!#t#z#

generatie nonsteroidieni steroidieni

I #!in'&$teti!i"

te)t%tne

II 4#"rz& 4r!e)t#ne

III #n#)trz&&etrz&

e3e!e)t#ne


24/31

St#n"#r"$& #%t$#& in tr#t#!ent$&(r!n#& #& %#n%er$&$i !#!#r

a trata!ent ad,*+ant

Pre!eno'a*(a

An#&' LHRH Ter#pie #ntie)tr'eni%# @ T#!3i4en - #ni

Post!eno'a*(a

Ter#pie #ntie)tr'eni%# - t#!3i4en ;-> #ni0 )it%( in(i*itri "e#r!#t# p#n# #ni

a trata!ent in boa&a !etastatia

Lini# I - p#%iente %$ *# !et#)t#ti%# 4#r# %riz# ,i)%er# HER-0 %$ re%eptri ER prezenti

F$&,e)tr#nt-tr#t#!ent "e &ini# #;# p#%iente %$ %#n%er !#!#r!et#)t#ti% in p)t!enp#$z# "$p# e)e%$& ter#piei %$ t#!3i4en


25/31

HORMONOTERAPIA IN CANCERUL DEPROSTATA


26/31

St#n"#r"$& #%t$#& in tr#t#!ent$&(r!n#& #& %#n%er$&$i "e pr)t#t#

Tr#t!ent$& (r!n#& e)te rezer,#t p#%ienti&r %$ *#!et#)t#ti%# )# &%#& #,#n)#t# .4#r# in"i%#tie "epr)t#te%t!ie )#$ r#"iter#pie %$ tint# %$r#ti,#/

-

p#%ientii 4#r# %#)tr#re %(ir$r'i%# @ *&%#"# #n"r'eni%#tt#-#n#&' LHRH )i #nti#n"r'eni )#$ n$!#i #n#&'iLHRH

- p#%ientii %$ %#)tr#re %(ir$r'i%# @ #nti#n"r'eni )#$*)er,#tie

- S%(i!*#re# &iniei "e (r!nter#pie in %#z "e pr're)ie #*&ii


27/31

I)tri# (r!nter#piei in %#n%er$& "epr)t#t#


28/31

Hr!nter#pi# in %#n%er$& "epr)t#t#

&asa Media!ent Ni+e& de ati*ne Mod de ati*ne

A'ni)ti LHRH Le$pr&in0 ')ere&in '& pit$it#r# S%#"ere# )e%retiei"e LH

Ant#'ni)tiLHRH #*#re&i3 In(i*#re# "ire%t# #re%eptri&r "eLHRH

In(i*itri enzi!#ti%i

#"ren#&i

et%n#z&0

#*ir#tern

'& pit$it#r# S%#"ere# )intezei

"e #n"r'eni "inpre%$r)rii)teri"ieni-in(enzi!e&r C=t P


29/31

CRH8LHRH #n#&'8#nt#'ni)t LHRH

ACTH

FSH8LH in(i*itie!e"i%#!ent#)# # CSR

%#)tr#re %(ir$r'i%#

An"r)ten"ine #n"r)ten"ineDHEA te)t)tern

%e&$Te)t)tern

pr)t#ti%#

(ipt#!$)

(ip5z#

CSR

te)ti%$&


30/31

%e&$ pr)t#ti%#

R *&%#nti

re%eptr#n"r'en

DHT

in(i*itri "e re"$%t#z# re"$%t#z#

te)t)tern

n$%&e$


31/31

Rezi)tent# (r!nter#pie

Pri!#r#-prin e3i)tent# $nei !$t#tii in %&n# t$!r# %e re"$%e )#$

e&i!in# re%eptrii (r!n#&i )#$ !&e%$&e pe %#&e#tr#n)!iterii )e!n#&$&$i ni,e& n$%&e#r

-prin %e3i)tent# $nei %#i #*er#nte "e pr&i4er#re )i)$pr#,iet$ire

Se%$n"#r#

-prin )e&e%ti# in ti!p # $nr %&ne nn(r!nre)pn)i,e-prin "ez,&t#re# $nr !e%#ni)!e "e )$nt#re-)intez# "e %#tre

%e&$ t$nr# # $n$i nr !#i !#re "e re%eptri (r!n#&i%$ #5nit#te !#i !#re

04.-hormonoterapia-cancerelor

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