Oncotype 27. Please help me decide on bout chemo!!!

Sunflower64

Hello everyone! Last time I was here was 7 years ago! Unfortunately I'm back.

Well I've had a new cancer and my oncotype score was 27! My tumor board met and they decided that I should do 4 cycles of chemo. I really need help with the decision. A 27 is in the intermediate range and there are no studies on chemo benefit. Of course I don't want to do chemo again.

Any advice would be so appreciated!

Thank you in advance

NancyHB

Sunflower - so sorry you find yourself here again after 7 years! I hope you don't mind my asking, but is your recurrence a local recurrence (same area as your previous cancer) or in a different area (or even the other breast?) 27 is that odd in-between score that I think might make chemo a tough choice in an initial diagnosis of cancer, but I'm not not certain I'd be quite as hesitant with a recurrence. I see from your stats you're PR- and Her2-, and I'm wondering if you know your ER+ percentage? If it's lower, that might explain the higher score. What does your MO recommend?

I recurred after four years, and just finished chemo (again) in June. My initial dx was ER+/PR-, Her2-, and my MO was only mildly surprised when my recurrence was TN, so I didn't have a choice to do chemo. It wasn't pleasant but it was doable, and I wanted to do everything I felt I could (including my diet and exercise) to ensure this doesn't come back yet a third time.

beebs2704

Sunflower, I'm a first timer but saw your score ...I'm a 26 and just made the same decision. I'm sorry to hear you are facing this again. My choice was left completely up to me..of course I'm in Canada which is a little different as I see more chemo recommendations from South of the border than here. It's a difficult decision for you. For me a little easier because I thought if I don't do it how will I feel with myself if I have a distant recurrence? I really do not want to have chemo mostly because I'm afraid, however I have a bigger fear of cancer returning somewhere less treatable. So I'm leaning into my fear of doing it and decided to go ahead. I'll take that 5% benefit

etnasgrl

I had the same score.....27 and opted OUT of doing chemo. Since I fell in the intermediate range, my oncologist could not tell me if the benefits to chemo would outweigh the risks. I didn't want to do chemo, but would have if I had known for sure that I would receive SOME benefit.
The side effects of chemo just scare me and some can be life long. I didn't want to put my body through all of that if I couldn't know for sure that it was doing some good.
That being said, this was my first time dealing with breast cancer. If this had been a recurrence, I would absolutely give the possibility of chemo much more thought! If it recurred once, it may again or possibly even mets down the road......that alone would scare me into doing the chemo. If the chemo could maybe prevent that from happening, it would be worth a shot, in my opinion.
But, that's just my opinion. There is no easy answer when it comes to this stuff. And it's hard to know what the right thing to do is.
I would gather as much info as you can, ask your oncologists as many questions as you need, listen to your gut, and then make the decision that is right for you.

Hopeful82014

Sunflower, I'm so sorry you're having to deal with this again.

I notice that your PR is now negative, whereas before it was positive, which would give me pause.

I can't guide your decision but if it were me, I would do chemo in the event of a recurrence and an upper mid-range intermediate score. I say this as one who does not embrace the concept of chemo and had no inclination to throw the kitchen sink at my tumor unless I could expect strong benefit from doing so.

Were you on AIs or hormonal therapy after your first dx? If so, the fact that it recurred after chemo AND while on HT would seem to indicate that this cancer has some staying power, thus might require more chemo to get it under control again. On the other hand, have you talked with your MO about any of the AIs in combination with another drug such as Ibrance? (I don't know if these are available for your situation but it might be worth asking.)

I'm sure it sks big time to even contemplate doing chemo a second time, no matter how you frame it. I'm sorry you're facing this. Good luck with your decision making and further treatment.

KBeee

27 is definitely on the high end of intermediate. I have been through chemo twice. It was easier physically the second time, but more challenging mentally.

Perhaps you could request the mammaprint; it had no intermediate.... Just high or low risk. You could also retest a second opinion.

You also need to consider your general health, your age (as far as how many more years you likely have to live), and what percentage of benefit you want to see. These are hard decisions. As someone who has s big family history snd had s recurrence, I wanted to hit it hard, but ultimately it is up to you. Best wishe

barcelonagirl

Hi Sunflower 64

I'm so sorry that you're going down this road again. Everyone is providing such great insight, and I thought I would add info on the findings of the MINDACT study below. This was recently posted on the breastcancer.org site, too. I was an ODX intermediate 21, and the definitive results of the MammaPrint (MP) test helped determine the best course of treatment for me (MP came back High risk, so completed 8 rds of chemo). I'm now an advocate for Agendia, as it indicated a benefit from chemo that my doctors were not expecting. That said, I know of ODX results of 28 that came back MP low! Agendia also ran a prospective study called PROMIS, which evaluated the results of intermediate ODX against the MammaPrint test, and reclassified 45% as Low Risk as 55% as High Risk. You may want to ask your doctor about running a MammaPrint test, and as KBeee said, take all the other factors into consideration. Sending you warmth in this tumultuous time.

70 Gene Signature as an Aid to Treatment Decisions in Early Stage Breast Cancer

BACKGROUND

The 70-gene signature test (MammaPrint) has been shown to improve prediction of clinical outcome in women with early-stage breast cancer. We sought to provide prospective evidence of the clinical utility of the addition of the 70-gene signature to standard clinical-pathological criteria in selecting patients for adjuvant chemotherapy.

METHODS

In this randomized, phase 3 study, we enrolled 6693 women with early-stage breast cancer and determined their genomic risk (using the 70-gene signature) and their clinical risk (using a modified version of Adjuvant! Online). Women at low clinical and genomic risk did not receive chemotherapy, whereas those at high clinical and genomic risk did receive such therapy. In patients with discordant risk results, either the genomic risk or the clinical risk was used to determine the use of chemotherapy. The primary goal was to assess whether, among patients with high-risk clinical features and a low-risk gene-expression profile who did not receive chemotherapy, the lower boundary of the 95% confidence interval for the rate of 5-year survival without distant metastasis would be 92% (i.e., the noninferiority boundary) or higher.

RESULTS

A total of 1550 patients (23.2%) were deemed to be at high clinical risk and low genomic risk. At 5 years, the rate of survival without distant metastasis in this group was 94.7% (95% confidence interval, 92.5 to 96.2) among those not receiving chemotherapy. The absolute difference in this survival rate between these patients and those who received chemotherapy was 1.5 percentage points, with the rate being lower without chemotherapy. Similar rates of survival without distant metastasis were reported in the subgroup of patients who had estrogen-receptor-positive, human epidermal growth factor receptor 2-negative, and either node-negative or node-positive disease.

CONCLUSIONS

Among women with early-stage breast cancer who were at high clinical risk and low genomic risk for recurrence, the receipt of no chemotherapy on the basis of the 70-gene signature led to a 5-year rate of survival without distant metastasis that was 1.5 percentage points lower than the rate with chemotherapy. Given these findings, approximately 46% of women with breast cancer who are at high clinical risk might not require chemotherapy.

Sunflower64

bump for more opinions

ruthbru

Well, crap, as much as I would not want to; I'd do the chemo if I was healthy otherwise and under the age of 75 (which is the cut-off age I decided on when I was doing chemo myself and thinking a lot about stuff like that). Best, best of luck in your decisions.

Lisey

Sunflower, your stats confuse me. a 1B means it's in your nodes... a 1A means it's not. You list you now are 1B - which means nodes, is that accurate? If so.. you definitely should do chemo. This would be twice it's in your nodes and you are slowly losing your ER+, which means hormonals won't help. Plus you never answered the question of whether you were on Hormonals this whole time? That would also be a factor - because it would mean hormonals didn't stop it. Please update and then people can give better advice.

katsie

I'm sorry for your problems with BC. I've had it 3x's and experiencing it the 3rd time right now. Treatment has been for 10 months so far. The chemo reduced the huge tumor on my chest. It has spread to my lung and kidney, so they will not operate. My doctor said if you have more than 2 tumors they will not remove them. I think you have to trust your doctor, and ask a lot of questions. I would write down my concerns, and make an appt. to see him/her, and discuss it further. Ask your question to your doctor. Make them explain why they want to do the chemo. I did chemo twice, and the first was very successful. I was not sick at all. The one now, has metastacized (sp), and it did not look like BC. I've been in treatment since January with radiation and chemo in IV form. Again, the chemo did not make me sick. At the end of August, 2016, my doc put me on Xeloda for the lung tumor which stopped responding to the IV Chemo. I have three tumors now, and they are inoperable. If I had only two, my doc, said they would have removed them . Don't be afraid to ask questions. Good luck.

Meow13

Well, my score was a 34 and I didn't do chemo. I am 5 years out er+ pr-, her2 neg. I did 4 years AI.

superius

I also acored a 27. I did Chemo. MO recommended it & my MD church people agreed - 3 surgeons, 3 Oncology Researchers, an Endocrinologist & a Dosimetrist - who also presented my case at her weekly Oncology meeting with the MOs she worked with. Basically the thought is, if you are younger, they want to be on the Offensive, more pro-active & treat it aggressively.