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Breast Cancer • Medical Oncology • NCI-CCC Tumor Board Question • UCLA • ASCO Journal Club • HR+ • NCI-CCC Breast Tumor Board Question
What is your strategy for ovarian suppression if unable to achieve goal estradiol levels with leuprolide 3.75mg monthly dose?
Data from the SOFT/TEXT trials showed clinical benefit in ovarian suppression + aromatase inhibition for high risk, premenopausal women with hormone receptor positive breast cancer, making ovarian suppression a consideration that can be achieved in numerous ways. Do you titrate the dose of leuprolide, switch to goserelin, discuss oophorectomy, refer to Radiation Oncology for ovarian ablation or abandon ovarian suppression + AI altogether and go back to treating a premenopausal women with tamoxifen?
Answer from: Medical Oncologist at Academic Institution
Monthly therapy rarely fails to induce adequate suppression. The choice of options will depend on whether the patient planned permanent or only temporary suppression AND the risk of recurrence of the cancer. If she will accept permanent suppression and has high risk disease, oopherectomy would be th...
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Answer from: Medical Oncologist at Community Practice
As shown in the SOFT-EST substudy, lack of ovarian function suppression with the use of GnRHa can be observed in up to 20% of the patients receiving this treatment. Main risk factors appear to be no prior exposure to chemotherapy, very young age and high body mass index. Although the lack of ovarian...
Answer from: Medical Oncologist at Academic Institution
I agree with @Kathy Miller—if the patient has no desire for future pregnancy, I usually advocate for BSO. If future pregnancy is a possibility, I switch to tamoxifen or tamoxifen +OFS.