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Alternatives to tamoxifen?

Page last modified on: October 10, 2008
Question from Tri: What is the latest research on a premenopausal woman, estrogen-positive but cannot take tamoxifen due to a clot disorder (Factor V Leiden)?
Answers —Andrew Seidman, M.D.: I will answer the question in the absence of knowing what stage of disease you are at and what other therapies may or may not have been administered. As a general comment, for a premenopausal woman with ER-positive breast cancer of any stage for whom tamoxifen could not safely be administered, the intervention that comes to mind as being safe and effective returns to my earlier comment of targeted therapy in the 1800s—simply suppression of ovarian function either chemically, using agents called LHRH analogues, such as Lupron (chemical name: leuprolide) or Zoladex (chemical name: goserelin) or surgical oophorectomy (removal of the ovaries). To reiterate an earlier point, aromatase inhibitors, while they do not carry the risk of blood clots that tamoxifen does, cannot be recommended for a premenopausal woman with any stage of breast cancer.
Jennifer Armstrong, M.D.: While there is a lack of data concerning the safety of the use of tamoxifen with anti-coagulation such as Coumadin (chemical name: warfarin) for patients with Factor V Leiden deficiency (or other underlying hyper-coagulable state), depending on the individual history (and whether there had been previous venothromboembolic disease, or clots, and/or the severity of previous clots), this could be a consideration.

On Wednesday, July 19, 2006, our Ask-the-Expert Online Conference was called Targeted Therapies: What is Right for You?Andrew Seidman, M.D. and moderator Jennifer Armstrong, M.D. answered your questions about different kinds of targeted therapies and how they work.

The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Meet the Experts

Andrew D. Seidman, M.D.Andrew D. Seidman, M.D. is an attending physician for the Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, and a professor of medicine, Joan and Sanford I. Weill Medical College of Cornell University.

Jennifer Armstrong, M.D.Jennifer Armstrong, M.D. is a breast cancer oncologist at Paoli Hematology-Oncology Associates in Paoli, Pa., with a special interest in physicians' communication skills.

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