Matteo Lambertini, MD, PhD:Usually what I do, especially during the first years, I try to check at least 3 times during the first years the estradiol level just to be sure of what’s going on and that we are actually suppressing [in the right way] the ovaries of our patient. Because we have data [especially] again from the SOFT [NCT00066690] and TEXT [NCT00963417] trials that there are some risk factors for not complete suppression in this setting with pharmacological OFS [ovarian function suppression], like high BMI [body mass index], very young age, not receiving chemotherapy, not being adherent to treatment, which is another factor that we should take into consideration. So if I have these factors, 1 of them, 2 of them, all of them combined, I tend to not give an AI [aromatase inhibitor] together with OFS because then I’m a bit more concerned [about] the real need for complete OFS, and then I am more comfortable for tamoxifen that can be given also, potentially, without a complete OFS.

Virginia G. Kaklamani, MD, DSc: So for these patients [for whom] you [check] an estradiol [level] and you find it higher than your postmenopausal level, how do you address that? Do you give a higher dose of the GnRH [gonadotropin-releasing hormone] agonist, which I’ve seen people do, or do you just make sure that you switch them to tamoxifen, continue the OFS, and hope for the best?

Matteo Lambertini, MD, PhD:Very difficult question and answer not based on a lot of evidence, a lot of data. What I do in my practice, I usually check again [estradiol] 1 month later.… I will leverage just to be sure that this is not just a single evaluation with other issues of the assay and so on. If this is confirmed, what I try to do is to shorten a bit the [1-]month administration for a few days, maybe, going for a 3-week administration instead of a 4-week administration. Then, if this is confirmed, I switch to tamoxifen. On the other side, if I have a very high estradiol level, I feel that I should trust these results, I directly move to tamoxifen. I still keep OFS, because with tamoxifen, even if it’s not suppressed, it’s not the problem, but in those cases, I move to tamoxifen. Can I ask you what you do in this regard?

Virginia G. Kaklamani, MD, DSc: Yes, so, I’ll switch to tamoxifen as well. I have not used a higher dose of GnRH agonist. I don’t think that there’s data to support that, but I do switch to tamoxifen. At least I feel a little more confident that my patient is getting suppressed, and I talk to them, especially the higher-risk patients, about bilateral salpingo-oophorectomy, and whether that’s something that they would like to do. I know that a lot of these patients will want to do that because they don’t want to be coming in for a monthly shot, and if they’re in their mid-40s and we’re planning on suppressing them for the rest of their reproductive years, it really doesn’t make a difference whether you remove their ovaries or whether you continue with monthly injections. [These patients] tend to find it easier and more of a peace of mind.

Transcript edited for clarity.