Does Oncotype apply on young women with larger tumor size?

SoffeeH

Hi all, it's my first time post here!

It's been a month after my mastectomy, and I'm still struggling on my treatment plan, so would like to hear your thoughts!

I'm 39 yrs old, IDC, 2.9cm, Grade 2, ER+/PR+/HER2-, Node 0/2, LVI present. My Oncotype came back with a score of 16, and 4% of distance recurrence risk at 9 yrs with AI or TAM alone, and <1% Chemotherapy benefit. My MO wouldn't want me to do the Oncotype at first place since he thought my score would fall on the grey area (which it did), and he would still preferring me doing chemo anyway. After showing him my Oncotype score, he thought it's still necessary, only with lighter regimen (from ACx4+Tx4 to TCx4). I consulted another oncologist, he said no chemo with confidence, and thought using Tamoxifen with ovarian suppression would be good enough. I'm really stuck here! Since it's already 5 weeks after my surgery, I really don't want to missed the optimal time of initiating chemo if it's really necessary! Any advice or insights would be appreciated. Feel free to share if you have similar experience, thanks!!

buttonsmachine

Can you see an oncologist at an NCI designated cancer center, if you haven't already? Maybe get a 3rd opinion? In my experience those centers are more familiar with how to treat breast cancer in younger women. It is a little different for us.

As for chemo, it must ultimately be your decision. If there truly is only a 1% benefit to doing chemo, it might not be worth the potential damage that chemo causes. On the other hand, if you're more comfortable knowing you did more treatment, that's also a factor.

I did a lot of chemo, and sometimes it didn't even work well. It's a hard situation, but I hope you find some answers here. Best wishes!

letsgogolf

SoffeeH I am a bit confused by your Onco score being 16 and having a 4% distant recur. rate. My score was a 3 and I had a 4% distant recurrence rate. I know 2 different people who had a score of 16 and their recurrence rate was 11% on their report. Has something changed recently with how they do the scoring?

Beesie

letsgogolf, what has changed is the TAILORx results, which for the low and intermediate scores found a much lower rate of recurrence for those who had endocrine therapy only versus the previous studies. Patients with scores of 26 and above were not given the option of endocrine therapy only, so there is no way to know how that group would have fared versus previous results.

Here are the TAILORx results, split by age (50 and under, and over 50). The blue solid line is endocrine + chemo and the red solid line is endocrine therapy only. (Source: Appendix documents from NEJM July 12, 2018 article.

Edited for typos only