40y, ER+/PR+/HER2-. Onco20. Chemo vs Lupron+AI

ailuj9

More questions (BC I keep getting SO much info, which is great, but can be channeling to decipher thru all the data/info). I am 40, invasive ductal carcinoma diagnosed in January 2021. Receptors: ER+/Progesterone+/HER2 negative. ER and PR% in the 90's. Had lumpectomy (tumor size 2cm) with negative sentinel lymph node biopsy. Oncotype 20. Technically I am stage 1a and grade 2. Still deciding to do chemo vs not do chemo. (TC x 4 rounds)...and now have the option to do Lupron +AI (and skip chemo) or Lupron + AI (+ chemo). Thoughts? I realize I am lucky to have choices, but am terrified of "making the wrong one". I know whatever I choose I will "have to live with"....IDK. Anyone had to make similar decisions. Thanks in advance

kathabus

Gah—that’s a hard call. Does your oncologist lean toward one of those options?

I was kinda faced with something similar. I had a low oncotype score (10) but a positive lymph node (8mm). I opted for an oopherectomy and the AI. I felt that being premenopausal....that was a fairly aggressive route. I was scared about not doing chemo but my team felt that even with the positive node the most benefit was the aromatase inhibitor treatment because of the high ER/PR.

I would really insist on a straight up opinion from your MO and I would probably seek out a second opinion if you are struggling. That’s what I would do. Because as much as we all want to throw the kitchen sink at this, you can’t take either route lightly. Good luck with this decision!

OnTarget

I was higher risk than you and I went with chemo, AI, Zoladex.

Chemo was a tough choice. My oncotype was 16.

I decided that a 5% chemo benefit was worth it, and to find that, I asked my MO to run the RSPC score on the Oncotype website for me. My recurrence risk was 13% without chemo I think.

I also consulted the TAILORX results that add risk and age. That said my chemo benefit would be more than 5%.

The study is here, check Table 2.

https://www.nejm.org/doi/full/10.1056/NEJMoa190481...

As a note, the Oncotype website uses the TAILORX study results to tell you your recurrence risk if your score is under 26. But the Oncotype results don't include age and clinical risk, even though the data is available.