Neo-adjuvant chemo & Residual Cancer Burden (RBC) test

Springtime

I had neoadjuvant chemo & surgery end of last year. Recently, after my husband and I talked to my ONC, she ordered the "residual cancer burden" (RCB) test to be done on the remaining tumor. There are apparently 4 categories that seem to be to relate as follows"

0 - complete response
I - near complete response
II - partial response
III - chemo resistant

I was a II with a score of 1.47. This is not a surprise to me as I had a partial response to chemo, as measured by the feel of and MRI scans of my tumor before, during and after chemo.

Have any of you had this test? Or know anything else about it?

I could not find much out there in google, or on this site. Seems like it may be new-ish and they are correlating it with the 30 gene profile. 

Any info, let me know! 

Spring.

lexislove

I had the test spring, but didn't ask much about it.  I didn't even know they performed it on the remaining tumor untill months AFTER surgery....lol

Springtime

Thanks Lexi, sounds like it's new and they're not sure what to do with it anyway. Do you remember your score or anything like that?

lexislove

My score was 0+.

 It said I had DCIS noted 1.3cm..

Springtime

Lexislove, and did you have a complete response to chemo? That would seem to match, if you did! Like the tumor just shrunk away to nothing?

lexislove

I had DCIS noted..may understanding is chemo doesn't have an effect on DCIS?....I have heard this somewhere...

My tumor was 8cm, after 3 AC's it wasn't palpable. I think I had the response like I did because I was Her2+. If I wasn't, and was just Er+ I'm not as sure if I would have had the same response.

Springtime

Yes, I had 40% DCIS on biopsy, and then none noted at all at time of surgery! I also thought DCIS would not react to chemo (that's what my BS said) but when I asked my onc, how could there be no DCIS after chemo, she thought the chemo zapped it.

Very confusing! I had also heard that with ER+ (and no Her2+) that you would likely get a partial response, about half gone, which is what I got. 

On MRI it started as 6.7, and at final surgery 3.5, and all sort of breaking apart (significantly less confluent). 

It still sort of bugs me, I wish I would have had a comlete response to chemo, you see much better statistics for disease free rate and survival rate with CR!!!!

Just have to breathe and trust I guess!

Spring. 

lexislove

Spring,

I Found my path report, and I did have some IDC left as well. The mass was 1.3cm and consistant of DCIS and IDC. A CR is rare, it does happen but usually with TN as I uderstand. CR is a prognostic factor, but there are many others. Big + for you is no lymph node involvment, as that is the most important factor.

Springtime

Yes, I've heard same that CR with Trip. Neg is most likely, which is a good thing as there's nothing else like Herceptin or the Hormone blocking/supressing drugs...

My path noted "vascular invasion" and my ONC was not happy about that. I asked her, is that like a positive lymph node? She said, well, it's sort of between having nothing and a positive lymph node. (Whatever that means! )

I am often very thankful indeed that no nodes were involved. Don't you find it interseting, in our cases, with large tumors, that there were no nodes? I wonder if that is like a different "class" or something. It is just always notable to me how many different forms this takes...

Spring.

PS this has become the Springtime / Lexilove thread! lol. GIGGLES.

lexislove

lol....My own thread!!!!

I had my mamogram and ultrasound before I was diagnosed. Nothing looked suspicious. My onc and surgeon could not palpate any lymph nodes. But..of course they said we have to wait till we do a biopsy and SNB to be sure. My breast biopsy was positive and my SNB was negative. I was like WTF. My surgeon said that 90% of tumors my size have lymph node involvment, I happened to be that other 10%. I know god answered my prayers that day. I did the neo adjuvant and at the time of my mastectomy they removed 5 or 6 more nodes to be "on the safe side". They were clear. My onc said given the fact that my SNB was negative and I had residual IDC in the breast at sugery , my lymph nodes were never involved.

My onc called my tumor a "pig"..it just wanted to eat and eat but not move.

There is another woman on the boards who had 10cm tumor and no nodes...it happens

Springtime

Well, all I can say is, "here's to PIGs!" I must have had a pig too. Thank God! My friends say it was big and stupid and all alone.

I ran a calculator, it would help predict the liklihood of node involvement for different types of tumors and different sizes. Mine was 85%. 

I sort of knew that, but seeing it there in front of me, well, Thank you God. 

Spring. 

angicpa

I just finished studying my path report and looking up terms etc online.  I did get an RCB 1.301 on my report. There was a swollen node before chemo, then it was not palapable and the SNB at mx time was negative.  Primary tumor bed area was 26mm x 26mm, overall cancer cellularity is 5% of which 50% was in situ.   There's the info for what it's worth.  University of Texas, MD Anderson Cancer Center came up with the calculator. I put in the info from the path report and got the same score.

Something interesting I read was a study that indicated "women with RCB-0 or RCB-1 after neoadjuvant T/FAC had excellent 5-year relapse-free prognosis irrespective of whether or not they received adjuvant hormone treatment". 

 I like that pig analogy.

I found another calculator online that, given my history, I only had a 6.7% chance of getting breast cancer anyway. Hmph!

Springtime

Angicpa, sounds like you have an excellent result!

SallyBandit

MD Anderson hosts an RCB calculator on their website (I'm not permitted to post the link here).  Refer to your pathology report for values to plug in.