A New Treatment Modality for Palliative Care Oncologists-Progesterone Receptor Modulators for very Advanced Cancer

In the last 15 years, there has been several presentations at national and international cancer meetings and multiple publications showing marked palliative benefits with significant extension of life in patients with very advanced cancers especially those where the cancer is devoid of the classical nuclear progesterone receptor by treating the patients with the progesterone receptor antagonist/modulator mifepristone. The target appears to be the immunomodulatory protein known as the Progesterone Induced Blocking Factor (PIBF). This drug is very well tolerated and given as a simple daily oral pill. Unfortunately, oncologists seem to be reluctant to treat even end stage patients with cancer with an off-label drug. Thus, when the patient’s cancer has extensively metastasized, and there are no other treatment options, the patient is referred to hospice to relieve pain and suffering while the patient’s family and friends pray for a quick death. This perspective/ commentary will show that the use of mifepristone, and possibly even better progesterone receptor modulators that could be developed, is the proper next step before preparing for death so that the patient can still look forward to a functional extension of life without suffering. The hope lies in the palliative care group to hopefully substantiate the efficacy of the drug and thus revolutionize the treatment of end-stage cancer.