What adjuvant endocrine therapy would you recommend for a male patient with HR positive breast cancer and history of DVT/PE?
For a male patient with Breast Cancer, with a history of DVT/PE, I would prefer to avoid tamoxifen and would recommend an aromatase inhibitor (AI) with a gonadotropin-releasing hormone (GNRH) analog for 5 years.
The rationale of adding GNRH analog (e.g goserelin) is that the use of AIs will lead to a lack of complete estradiol suppression in men treated with aromatase inhibitors thought to be due to feedback loops to the hypothalamus and pituitary glands, which can be overcome with the addition of a GnRH analogue.
Using AI without GnRH analog will likely increase testosterone, which can convert into estradiol ( in fact many bodybuilders use AIs to build bulky physique based on the excessive levels of testosterone produced which can also cause side effects)
The following are 2 good references on this topic
Multidisciplinary meeting on male breast cancer: summary and research recommendations.