Transdermal Oestradiol FAQs

 

a. What should I do if a patient’s oestradiol result is too low (<300pmol/L)?

A low oestradiol result often indicates issues with compliance or incorrect patch application, so please check this with the patient. If this is the first time the oestradiol has been out of range, please run a repeat test in 4 weeks (being careful to time this the day before the patches are changed). If the oestradiol has been persistently out of range, please request advice from the STAMPEDE team (mrcctu.stampede@ucl.ac.uk).

 

b. What should I do if a patient’s oestradiol result is too high (>2000pmol/L)?

If this is the first time the oestradiol has been out of range, please run a repeat test in 4 weeks (being careful to time this the day before the patches are changed). If the patient’s oestradiol is particularly high (>4000pmol/L) at any time, please run a repeat test in 1 week. If the oestradiol has been persistently out of range, please request advice from the STAMPEDE team (mrcctu.stampede@ucl.ac.uk).

 

c. What should I do if a patient’s testosterone result is too high (>1.7nmol/L)?

Induction dose: If a patient's testosterone is still >1.7nmol/L after 4 weeks on the induction regime (4 patches changed twice weekly), they should remain on the induction regimen for another 4 week period, and have a repeat hormone test at the week 8 time point. Once the patient achieves a castrate level of testosterone (≤1.7nmol/L), they can be reduced to the maintenance regimen (3 patches changed twice weekly). If the testosterone does not reduce below 1.7nmol/L, please request advice from the STAMPEDE team (mrcctu.stampede@ucl.ac.uk).

Maintenance dose: If this is the first time the testosterone has been out of range, please run a repeat test in 4 weeks. If the testosterone has been persistently >1.7nmol/L, please request advice from the STAMPEDE team (mrcctu.stampede@ucl.ac.uk).

Please note: if both the testosterone and oestradiol are high, please check if the patient has been prescribed tamoxifen. Tamoxifen is not a permitted concomitant medication for patients using transdermal oestradiol as it can stop the patches functioning as they should.

 

d. The patient is having trouble with the patches falling off. What can I recommend?

Please check if the patient has been following the application instructions (“To apply the patch, remove the protective liner and then press onto skin immediately and hold for at least 30 seconds to ensure proper adhesion”). It is recommended that patches are placed on dry, intact and hairless skin and on areas where little wrinkling occurs. He can also try using tape to keep the patches on.

If applied correctly, the patient should be able to bath or shower as normal, however the patches might come off in very hot water or in a sauna. If patches become dislodged they should not put on extra patches, but apply their next set of patches when they are next due to be applied

 

e. The patient is having trouble with adhesive residue left on the skin from the patches. What can I recommend?

There is no official guidance, but some sources have different suggestions, such as:

  • Waiting until the adhesive is dry before attempting to remove it
  • Using a small amount of oil (e.g. baby oil, olive oil)

If you or your patients find any particularly effective methods, please share your knowledge with the STAMPEDE team!

 

f. The patient is experiencing a rash/itchy skin on the patch application area. What can I recommend?

Please ensure the patient is rotating the site of patch application between the shoulder girdle, back, upper arms, and buttocks and is waiting at least a week before applying patches to the same site. We advise the site team review the rash, and may advise the patient uses a low-dose steroid cream on any areas of irritation after removing the patches.

 

g. The patient has had one 4-week LHRH injection and been on anti-androgens prior to randomisation to Arm L. When can they start using tE2?  

There is no washout period and the patient can commence tE2 treatment immediately after randomisation. Patients should stop taking anti-androgens (e.g. bicalutamide) before starting on tE2.

 

h. The patient is discontinuing tE2 treatment. When can they start their next line of therapy?  

There is no washout period and patients may start their new treatment immediately.

 

i. How do I order transdermal oestradiol?

Pharmacies should order Bayer Progynova TS 100 patches through Alliance Healthcare. A discounted rate is automatically applied for STAMPEDE sites. Please contact the Arm L Trial Manager (mrcctu.stampede@ucl.ac.uk) if this discount is not in place for your site.

 

Have another question or looking for more information? Why not check out the STAMPEDE Training Suite for the training slides detailing information on STAMPEDE.

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