Would you consider switching endocrine therapies for a peri-menopausal woman on adjuvant tamoxifen solely due to an estradiol level if this was checked and found to be significantly elevated?
Patient had estradiol level checked by her gynecologist due to recent irregular bleeding. Estradiol level was markedly elevated on initial testing (900-1000 pg/ml) and improved on repeat testing (600-700 pg/ml).
Knowing that tamoxifen can lead to elevated estrogen levels, would this be at a high enough level for you to be concerned? Do you use a certain cut off?
Answer from: Medical Oncologist at Academic Institution
I agree with Dr. @Khong that this is likely ovarian hyperstimulation from tamoxifen which can occur in 9-17% of women and is more likely to occur in younger women treated with tamoxifen therapy alone. In one study, a level of over 300pg/mL and follicular diameter over 30mm were used to define OHS. (...
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Answer from: Medical Oncologist at Community Practice
Tamoxifen is a potent inducer of ovarian function. If on adjuvant tamoxifen and the estradiol level increased to that extent, I would consider adding an LHRH agonist (such as goserelin). Tamoxifen can be continued at that time or switched to an AI, depending on the patient's risk factors.
Comments
Medical Oncologist at Colorado Permanente Medical Group Hematology & Oncology
I would like to know more about why you would swit...
I would like to know more about why you would swit...
Medical Oncologist at St. Charles Cancer Center
Agree with Dr. @Susan M. Freeman. We usually do no...
Agree with Dr. @Susan M. Freeman. We usually do no...