[jeff]

In the past this has been a much more common strategy in Europe, where Zoladex shots have been given to premenopausal women in conjunction with Tamoxifen, and now the AIs. Basically the AIs only work for women who are postmenopausal, so many are now choosing to become postmenopausal, either through having ovaries taken out (some use to have them radiated) or having their function suppressed with Zoladex or Lupron. Once the Lupron or Zoladex is clearly working (and there is some debate about how to demonstrate this) then it is ok to begin on AIs. Lupron is more convenient for some because it can be given in a three month dose. This is what Rachel is doing, and has had no problem with.

There are a number of huge trials testing a variety of hormonal approaches, including ovarian suppression + AI that are going on right now. This has been of particular interest to women with her2 disease because of the notion that many are tamoxifen resistant (and there is some thought that what is really going on is that a larger than expected number of her2 positive women are er+ but pr negative, and that this might be the key).

Best to all,
Jeff