Why gaps happen: toxicity, logistics, patient choice, comorbid events.
Goal: restart effectively without hormone flare or resistance.

Restart rules

Drug Class Restart note
GnRH agonists Re-induce slowly; use short anti-androgen cover for 2 weeks.
GnRH antagonists Immediate re-suppression — safe restart any time.
AIs/SERDs Restart same agent if pause < 8 weeks and no progression; otherwise switch class.
Tamoxifen Restart with anticoagulation review if prior VTE.

Bridging periods

  • Use short-acting LHRH analogs or low-dose steroids to maintain partial suppression.

  • Keep DEXA monitoring if gap > 6 months.

Communication tip: document “treatment holiday” reason and planned re-evaluation date in chart and discharge summary.

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