Oncotype testing with 4 Lymph nodes?

DonnaLousie

Hi,

It was recently suggested to me by a private pathologist that Oncotype DX now has recommendations for those with 4 to 9 lymph nodes. Is anyone familiar with this new outcome? If you are, is the research strong in its outcomes supporting those with 4 to 9 lymph nodes with recommendations and predictability

Thank You,

Donna

Dianarose

I have no faith in this test at all. I scored a six and now stage IV. Just my opinion

LeesaD

DonnaLousie- I'd be interested in this also. My Oncotype score was ordered after my BMX showed 2 sentinel nodes with micromets and prior to my ALND. Had ALND and they found 2 fully positive nodes so I had 4 involved nodes. After the ALND results my MO set up AC/ T
Chemo. Then my Oncotype result came back a 3. He was encouraged by the 3 and changed my chemo regime from AC/T to TC as the heart risk from the A drug he thought outweighed any benefit. He still felt like he had to give me chemo with the 4 nodes and he said in a couple of years we'll see what results are with Oncotype relevance and more than 3 nodes. I'd be very interested to see these recommendations. Can you ask the pathologist where these results are or if they've been published? I did a quick google search and can't find anything.

Icietla

• TransATAC Study³: Consistent with NSABP B-14 results for node-negative patients, this study confirmed that the Breast Recurrence Score test provides an improved estimate of risk of distant recurrence for node-positive patients. It found that a low Recurrence Score result was associated with a lower rate of distant recurrence, while a high Recurrence Score result was associated with a higher rate of distant recurrence.
• SWOG 8814⁴: This study determined that the Breast Recurrence Score test is associated with the likelihood of chemotherapy benefit in node-positive patients. A Recurrence Score result <18 predicted little to no benefit from chemotherapy, while a score ≥31 predicted a larger benefit from chemotherapy.

SWOG 8814 Study details⁴

The SWOG 8814 study analyzed archived tissue from 367 post-menopausal, hormone receptor-positive, node-positive patients with invasive breast cancer treated with tamoxifen or tamoxifen plus cyclophosphamide/doxorubicin/ fluorouracil (CAF).

In the study, the Recurrence Score result was shown to be prognostic for disease-free survival, overall survival, and breast-cancer specific survival in node-positive patients treated with tamoxifen alone as well as predictive of CAF therapy benefit. In addition, the SWOG 8814 study showed that the Recurrence Score result is also predictive of which node-positive patients will likely benefit from the addition of chemotherapy.

The analysis of chemotherapy benefit in disease-free survival by Breast Recurrence Score risk groups showed that only patients with a high Recurrence Score benefitted (p=0.033) and there was no significant benefit in patients in low or intermediate risk groups. See the full study report Results were similar for overall survival and breast-cancer specific survival.

TransATAC Study details³

The TransATAC Study further validated that the Recurrence Score result provides the risk of distant recurrence. It was conducted in samples from 1,231 post-menopausal patients with ER+ node-negative and node-positive disease enrolled in the ATAC trial.

Consistent with the NSABP B-14 study results for node-negative patients, the TransATAC study found that the Recurrence Score result was a statistically significant indicator of the risk of distant recurrence in patients with node-negative (p<0.001) or node-positive (p=0.002) disease, treated with either tamoxifen or anastrozole. In a multivariate analysis of node-negative patients that included tumor size, central grade, and age, the Recurrence Score result and tumor size were the only variables that were statistically significant in predicting time to distant recurrence (p<0.001). In addition, it was found that the 9-year risk of distant recurrence increases with the number of positive nodes for all Recurrence Score values. For patients with low Recurrence Score results and 1-3 positive nodes, the 9-year risk of distant recurrence was similar to that of patients with node-negative disease. See the full study report

Source: http://www.oncotypeiq.com/en-US/breast-cancer/healthcare-professionals/oncotype-dx-breast-recurrence-score/evidence-it-works

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Welcome, DonnaLousie.

Icietla

http://news.cancerconnect.com/oncotype-dx-predicts-outcome-of-node-positive-breast-cancer/

Icietla

This is from 2015.

"The Oncotype DX test has been validated for lymph node positive estrogen receptor-positive patients with a maximum of three positive lymph nodes."

http://www.breastcanceranswers.com/will-all-lymph-node-positive-breast-cancer-patients-need-chemotherapy/

Icietla

Who Might Benefit from the Oncotype DX Breast Cancer Assay?

The Oncotype DX breast cancer assay can be used by all patients newly diagnosed with early stage, invasive breast cancer who are:

• Node-negative or node-positive (cancer has spread to no more than 3 lymph nodes)
• Oestrogen receptor (ER) positive and
• Human epidermal growth factor receptor 2 (HER2) negative

https://www.stabiopharma.com/index.php?q=oncotype-dx-breast-recurrence-score.html

Icietla

Other genomic tests

There are other genomics tests used to analyze breast cancer tumors. To learn more, click on the links below.

• The Breast Cancer Index test is used to predict the risk of node-negative, hormone-receptor-positive breast cancer coming back 5 to 10 years after diagnosis.
• The EndoPredict test is used to predict the risk of distant recurrence of early-stage, hormone-receptor-positive, HER2-negative breast cancer that is either node-negative or has up to three positive lymph nodes.
• The MammaPrint test is used to predict the risk of recurrence within 10 years after diagnosis of stage I or stage II breast cancer that is hormone-receptor-positive or hormone-receptor-negative.
• The Mammostrat test is used to predict the risk of recurrence of early-stage, hormone-receptor-positive breast cancer.
• The Prosigna Breast Cancer Prognostic Gene Signature Assay (formerly called the PAM50 test) is used to predict the risk of distant recurrence for postmenopausal women within 10 years of diagnosis of early-stage, hormone-receptor-positive disease with up to three positive lymph nodes after 5 years of hormonal therapy.

http://www.breastcancer.org/symptoms/testing/types/oncotype_dx

Icietla

Sample Report for (hypothetical) case with 4 or more positive nodes.

https://www.stabiopharma.com/assets/files/r-oncotype-breast-sample4nodespositive.pdf

Icietla

See page 8 here.

http://www.tangence.com/public/genomic/newsletter/july-13/downloads/GHI10008_0613_Node-positive_Slide.pdf

This item is from 2017.

http://www.ascopost.com/issues/january-25-2017/breast-cancer-experts-question-new-recommendations-for-21-gene-recurrence-score-assay/

DonnaLousie

Thank you for all the information. The pathologist did sight a research study with node positive women but I can not recall the last name. I will follow up with the group and provide the authors name. It has challenging as I am on the fence with 4 nodes and onco score of 17. It seems like this intermediate to low group like myself does not have a strong evidence as other groups.

ClareCo

hi Donna Louise. I had 1/3 nodes positive, and was oncotype 19. I wrestled with the chemo question for about a week and then decided to do chemo. Once you make your decision either way you'll probably feel better--at least I did. Sending you strength - you'll figure it out and you will feel better

DonnaLousie

Hello Group,

Thank you for all of your replies. Here are two studies the pathologist provided me that I wanted to share. I have not had a chance to read these two studies but here they are:

Loncaster et al. 2017. Impact of Oncotype DX breast recurrence score testing on adjuvant chemotherapy use in early breast cancer. Eur J Surg Oncol, 43: 931-937.

Roberts MC et al. 2017. Breast cancer specific survival in patients with lymph node-positive invasive breast cancer and Oncotype DX recurrence score results in the SEER database. Breast Cancer Res. Treatment, 163: 303-310.

Thank You,

Donn