hmmm this case study makes no sense.... or maybe I'm just slow.

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Specializes in Critical Care, Trauma, Neuroscience.

Im wondering if you all could help me out. I have a question about a cancer case study, and I was hoping you could lead me in the right direction since I'm confused if I'm understanding it correctly. I've researched the question extensively, and it seems like the drug ordered doesn't make sense... anyway here it is:

The case study:

Agnes, age 52, was admitted to the hospital for a mastectomy for cancer of the left breast including the removal of seven lymph nodes. Three lymph nodes were found to have cancer cells. She was discharged and was scheduled for follow-up radiation therapy. Two years later, Agnes developed shortness of breath and a bone scan showed metastasis to the left lung. The health care provider removed Agnes' ovaries and she was placed on leuprolide acetate 1 milligram subcutaneous a day for one month.

2. Why was Agnes initially placed on leuprolide acetate following the removal of the ovaries?

It is my understanding that leuprolide acetate is a drug that is an LHRH agonist - which stops the production of luteinizing hormone by the pituitary gland. This reduces the production of estrogen and progesterone by the ovaries. Agnes' ovaries were removed because she has been diagnosed with breast cancer and breast cancers are often exacerbated by estrogen. It doesn't make sense to me that she is placed on leuprolide acetate after her ovaries are removed because suppressing leutinizing hormone would only have an effect on the ovaries. Since they are removed, what is the point of her taking the drug? I understand that there are other sources of estrogen in the body that may need to be suppressed, but leutinizing hormone does not have an effect on these other sources from what I understand...

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

http://www.cancer.gov/cancertopics/druginfo/leuprolideacetate

http://www.oncolink.org/treatment/article.cfm?c=2&s=10&id=351

google is your friend....

while estrogen and progesterone may not actually cause [color=#152864]breast cancer, they are necessary for the cancer to grow in some breast cancers. estrogen and progesterone are female hormones produced by the ovaries. the production of these hormones can be stopped by surgically removing the ovaries or through medication therapy. a hormone called luteinizing hormone, which is produced by the pituitary gland, stimulates production of estrogen and progesterone by the ovaries. lhrh agonists stop the production of luteinizing hormone by the pituitary gland. this reduces the production of estrogen and progesterone. the cancer cells may then grow more slowly or stop growing altogether. leuprolide acetate is a type of lhrh agonist.

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Specializes in Critical Care, Trauma, Neuroscience.

Thanks for your response :) However, I had already done that research and found the same information. That's why the question doesn't make sense to me because they are prescribing the LHRH agonist (Leuprolide acetate) AFTER the ovaries have already been removed! This is why I'm confused - trust me, google and I are bffs, practically lovers at this point :lol2:

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
http://www.cancer.gov/cancertopics/druginfo/leuprolideacetate

http://www.oncolink.org/treatment/article.cfm?c=2&s=10&id=351

google is your friend....

while estrogen and progesterone may not actually cause [color=#152864]breast cancer, they are necessary for the cancer to grow in some breast cancers. estrogen and progesterone are female hormones produced by the ovaries. the production of these hormones can be stopped by surgically removing the ovaries or through medication therapy. a hormone called luteinizing hormone, which is produced by the pituitary gland, stimulates production of estrogen and progesterone by the ovaries. lhrh agonists stop the production of luteinizing hormone by the pituitary gland. this reduces the production of estrogen and progesterone. the cancer cells may then grow more slowly or stop growing altogether. leuprolide acetate is a type of lhrh agonist.

there are some studies that giving the drug still reduces the production of estrogen whether or not the ovaries are intact to slow the advance of metastic disease. it's in one of the drug trials on the nih/cancer link..:D

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Specializes in Critical Care, Trauma, Neuroscience.

arrrrgh could you direct me to the link? For the life of me, I cannot find it! I'm finding that tamoxifen has effects on estrogen levels after ovary removal, but not Leuprolide...

Actually, the studies I'm finding are saying that the benefits of Leuprolide are that it can be given to premenopausal women to suppress the ovaries from producing estrogen without having to be removed (so they may be able to become pregnant later). Obviously this doesn't apply to my case study situation... http://www.cancer.gov/clinicaltrials/results/summary/2007/lhrh-agonist0607

According to wikipedia (which I know I shouldn't use LOL!), luteinizing hormone only stimulates estrogen production from the ovaries, but not anywhere else in the body. Sooo the drug administration still doesn't make sense to me. I guess I can make up something, but now I'm just honestly curious to see the study just because it doesn't make sense. The reason tamoxifen has effects on estrogen levels is because it effects the other estrogen sources (estrogens produced by other tissues such as the liver, adrenal glands, and the breasts, fat cells, etc.).

Thanks for directing me to these studies by the way, I passed over them before - very interesting!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

http://www.cancer.gov/clinicaltrials/search/view?cdrid=643729&version=healthprofessional&protocolsearchid=7619489

the purpose of this study is to determine the safety and tolerability of the combination of two drugs (letrozole and leuprolide) in women who have already taken tamoxifen for at least 4.5 years. letrozole, an aromatase inhibitor (which blocks an enzyme that produces estrogen), is a drug that is fda approved. it has been shown to reduce the risk of breast cancer recurrence in postmenopausal women with breast cancer who have been previously treated with tamoxifen. letrozole works by stopping the production of estrogen in parts of the body other than the ovaries. leuprolide is a drug that stops a women's ovarian cycles. this process is known as ovarian function suppression. stopping a women's menstrual cycle may be highly effective against breast cancer for some patients when given as initial therapy. the combination of letrozole and leuprolide is considered a standard treatment for women with metastatic breast cancer, and is also sometimes used for treatment of early stage breast cancer. however, it has not been accepted as a standard of care treatment.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

while estrogen and progesterone may not actually cause [color=#152864]breast cancer, they are necessary for the cancer to grow in some breast cancers. estrogen and progesterone are female hormones produced by the ovaries. the production of these hormones can be stopped by surgically removing the ovaries or through medication therapy. a hormone called luteinizing hormone, which is produced by the pituitary gland, stimulates production of estrogen and progesterone by the ovaries. lhrh agonists stop the production of luteinizing hormone by the pituitary gland. this reduces the production of estrogen and progesterone. the cancer cells may then grow more slowly or stop growing altogether. leuprolide acetate is a type of lhrh agonist.

http://www.oncolink.org/treatment/ar...=2&s=10&id=351

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Specializes in Critical Care, Trauma, Neuroscience.

Thank you so so much! That's exactly what I was looking for :)

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Thank you so so much! That's exactly what I was looking for :)

You showed a ton of inciative and overall understanding....I was happy to oblige. You're going to make a great nurse:D

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