Her2+++ and Oncotype ?

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jill323
jill323 Member Posts: 412
edited June 2014 in HER2+ (Positive) Breast Cancer

Hello... I have been getting some conflicting information and want to hear about the experiences of some who have been there.   I was told my by surgeon that typically the Oncotype test is not run on Her 2+++ invasive cancers because we already know the answer.  It will be high because of the statistics surrounding the recurrence risk associated with Her2 +++.  

However, I have seen some cases where the Oncotype test was ordered despite Her2+++.   Wondering if I should push my onc. for this test given I have a small tumor and am node negative to aid in decision making - or if that is just a waste of time and money.  

Also, for those familiar with Adjuvant !, can this software account for Her 2 status ?   It is not clear to me from all the documentation. 

 Would appreciate any perspective anyone has !

 Jill  

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  • Dejaboo
    Dejaboo Member Posts: 2,916
    edited September 2008

    Hi Jill.  Grr- My whole post was deleted!

    Ill try to write it again.

    I recently read that the Onco DX tes was not useful with Her2+ .

    So I wrote to Genomic Health & Asked.

    Here is their reply:

    "Thank you for contacting Genomic Health regarding Oncotype DX® Breast Cancer Assay. Oncotype DX® Breast Cancer Assay is validated for newly diagnosed, clinical stage I/II, ER positive and lymph node negative patients. It is not required for patients to be Her2 negative for testing, however Her2 highly positive patients would not benefit from testing. Should you have any further questions, please feel free to contact customer service."

    I then asked for them to explain their answer.   This is their reply.

    "Sorry for the confusion. Her2 highly positive patients will most likely fall in the high risk category and have a high chance of recurrence. Should you have any further questions, please feel free to contact customer service."

    That being said- Many women with Her2+ have the OncoDX test done..Most do come back high...But some dont.

    Do you know if your insurance will cover it?  if it does- I would have it done.

    I too have wondered about Adjuvant Online & Her2+.  I thought they were coming out with an updated version that included Her2+ But I have not heard if it is available yet.

    Pam

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  • jill323
    jill323 Member Posts: 412
    edited September 2008

    Pam - Wow !  Thanks for your resourcefulness.  I wish I had thought to contact them directly (duh!).   Really exasperating that they made you contact them twice !    I will check with my insurance, but I guess if the maker of the test themselves says they same thing my BS said, guess there is some truth to it.  

    I had seen the same thing about Adjuvant !, which is why I was asking.  I think you can mess around with the prognostic factors if need be with the current version, but I am not expert enough to even try that.   If I find out anything else, I will let you know.  

    Also, thanks for taking the time to post this twice.   Sorry you lost it the first time around.   But, I am glad you took the time to post again as I found this really helpful.

    Jill

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  • Dejaboo
    Dejaboo Member Posts: 2,916
    edited September 2008

    Hi Jill- Im glad to hear it was helpful.  If you feel like it - You coudl email  Genomic too & see what answer they give you.

    I didnt mind posting it twice- Was just hard to remember what I had said - LOL

    You are very Similar in your DX to me.  My ER is only Mildly positive 18% .  And our tumor sizes are both very small.  I am grade 1 where you are 2.   Oh My & I was Dx on March 7th!

    Im a Number person- I dont like the # 7 anymore because on May 7th I found out I had a hole in my heart.  No appts for me anymore on or near the 7th!  LOL

    Pam

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  • lisettemac
    lisettemac Member Posts: 213
    edited September 2008

    I am Her2+ and had the Oncotype.  First onc I consulted with suggested that I do the Oncotype, even though I was both Her2+ and had a poor grade.  In retrospect, I guess I should have anticipated what the results would be .... but truth be told, I was glad I got it.  I was arguing mightily against having chemo.  Second onc said there "was an argument" that I could skip the chemo (I was 1.1cm, no node involvement, but some cancerous cells in my lymphatic vessels).  We agreed that the Oncotype results would make the decision.  When they came back high, I relented and did the chemo.  Honestly, I don't think he could have convinced me to do it without the Oncotype.  And, my insurance paid for it, so I thought it was worth it.

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  • jill323
    jill323 Member Posts: 412
    edited September 2008

    Pam -

    First, let me say you have been through the gamut !  A hole in the heart as well as breast cancer ?!    I don't think I will ever look at the 7th the same again.   And yes, our diagnoses are amazingly similar.  I am also only weakly ER+ (22%).  Not too many of us ER+/PR- ladies around from what I can tell.   

    Anyway... I did what you suggested.  I contacted Genomic Health with a very specific question on this (and got the answer in one shot).  Here it is:

    Thank you for inquiring about the Oncotype DX® Breast Cancer Assay.  As you stated below, the Oncotype DX® Breast Cancer Assay is validated for testing on early stage female breast cancer patients who are ER positive and lymph node negative. Though the HER2 gene status of a patient is not required for testing (meaning a patient HER2 positive or negative can be submitted for testing), the majority of the tests performed by Genomic Health, Inc.® are for patients who are HER2 negative. A highly positive HER2 status through IHC or FISH testing will likely correlate to a high recurrence score and so testing may not prove beneficial. However, an equivocal or uncertain score for HER2 may prove to be HER2 equivocal or negative by RT-PCR (Genomic Health's method of testing HER2 and all other genes within the assay) and therefore results of the Oncotype DX® Breast Cancer Assay may prove extremely beneficial in determining average rate of distant recurrence. Beginning on September 27, 2008, the Oncotype DX® Breast Cancer Assay report will include the values for ER, PR, and HER2. These values are just three of the 21 genes used within the assay.

    I had heard the they had come up with a "new" way to test/report Her2/neu, but it appears to me that the original hypothesis is correct:  IF the tumor is for sure Her2+++ either by IHC or FISH, it will likely result in a high recurrence score in Oncotype testing.   It appears to me they are aiming to make this test the "one stop shop" type of test for node negative cancer.   Not a bad idea if you could get this in one shot instead of piecing information together. 

    Jill

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