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CDK4/6 Ovarian Recovery — SCE Medical Oncology MCQ

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HardBreast CancerCDK4/6 Ovarian RecoverySCE Medical Oncology

A 51-year-old considered postmenopausal after chemotherapy starts letrozole plus palbociclib for ER-positive metastatic breast cancer. Six months later menses recur and serial oestradiol is clearly premenopausal. What is the most appropriate interpretation and endocrine correction?

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Correct answer: D — Ovarian function has recovered, so add ovarian suppression to the aromatase inhibitor

Return of menses and premenopausal oestradiol show ovarian recovery, so reliable ovarian suppression must be added to make the aromatase inhibitor effective. Ovarian function has recovered, so substitute tamoxifen for letrozole and retain palbociclib: tamoxifen is an endocrine option, but standard metastatic AI treatment can be restored with ovarian suppression. Ovarian function has recovered, so increase letrozole dose and retain palbociclib: a higher aromatase-inhibitor dose cannot overcome functioning premenopausal ovaries. Ovarian function has recovered, so discontinue letrozole and continue palbociclib monotherapy: CDK4/6 inhibition requires an effective endocrine partner. Ovarian function has recovered, so substitute fulvestrant and omit ovarian suppression: fulvestrant also requires ovarian suppression in a premenopausal patient.

Reference: NICE NG81 advanced breast cancer: recommendations (Current NICE recommendations, accessed July 2026): https://www.nice.org.uk/guidance/ng81/chapter/Recommendations; Kisqali 200 mg UK summary of product characteristics (Current UK SmPC, updated July 2026): https://www.medicines.org.uk/emc/product/8110/smpc