SABCS--Confirmation of Chemo Benefit--Read It All!

Seabee
Seabee Member Posts: 557
edited June 2014 in ILC (Invasive Lobular Carcinoma)

A most interesting article, but beware of taking the headline as the whole story.  A subset of the study applying the genomic numbers confirmed the Oncotype DX data.  If you are post menopausal and node positive, and your Oncotype score is 18 or under, you can expect little or no benefit from chemo.

They don't get around to reporting this significant qualification until near the end of the article.

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  • wallycat
    wallycat Member Posts: 3,227
    edited December 2009

    Do you have a link to the article?

    I'm curious if anything about node negative and intermediate score was mentioned.

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  • yellowrose
    yellowrose Member Posts: 886
    edited July 2010

    It is in the BC.org breaking news.  Nothing written about the intermediate scores with no nodes or those with micromets to nodes.  Left wondering...

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  • Gitane
    Gitane Member Posts: 1,885
    edited December 2009
    This is Kathy Albain's report on an analysis they did of a subgroup of the SWOG8814.  This was a study of postmenopausal women with positive nodes.  In the original study there were 1477 women.  They took two groups out of the study to look at.  One group was the Tamox Only group and the other was the group that got Chemo(CAF) then Tamox.  They eliminated from their subgroup analysis the 234 women who got Tamox and Chemo together and also eliminated the women who did not have good tumor samples that Oncotype DX could measure.  That left 367 women out of the original 1477, or about 25% of the study.  They then got RS scores for those women and put them in their Low, Int., High RS groups and treatment groups (6 groups) and looked at their Breast Cancer Specific Survival.  In the abstract it says, "For the exploratory analysis of BCSS, only deaths due to breast cancer were counted as events, censoring deaths due to other causes (such as late cardiovascular events) as well as patients alive at the last follow-up visit.Below is the data that is presented on the poster, these are the actual numbers, not the 10 year estimates.  The fraction is # who died/# studied.  The poster says that there is an Interaction for BCSS by RS,  p=0.021.    Low RS    Tamox.  4/55(BCSS 92.7%)  Tamox + Chemo. 10/91 (BCSS 89.0%)                      Difference  - 3.7% Int RS     Tamox.  11/46 (BCSS 76.1%)        Tamox + Chemo  10/57  (BCSS 82.5%)         Difference  6.4% High RS     Tamox.  20/47 (BCSS  57.4%)  Tamox + Chemo  18/71  (BCSS  74.6%)         Difference  17.2% They were able to test 148 women on Tamox. and 219 women who had both Chemo and Tamox.  These are not very many women, so you can't get a lot of information from this,  but overall the BCSS for Tamox users was 76.4% and for Chemo+Tamox users was 82.6%.   If you would like to see the statistics and read the abstract of this study you can do so.  Step 1:  Google  this sabcs 2009 Step 2:  Click on  Enduring Materials (it's in the very first thing listed) Step 3:  Click on the link under Abstracts2View Abstracts from the 32nd Annual SABCS Dec. 10-13, 2009 Step 4:  Click on the box under Option 1 and Submit Step 5:  In the Search For box at the  top type the researcher's name (Albain) and hit return Step 6:  Click on the first Study to read the abstract or click on the orange P (in a circle) to see the poster of the study. When looking at the poster I can make it bigger or smaller on my computer by holding down SHIFT and OPEN APPLE and tapping the + symbol or the - symbol.  (I use a Mac). 
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  • Seabee
    Seabee Member Posts: 557
    edited December 2009

    I didn't supply a link because the headline is featured prominently on the right hand side of the discussion group site, and provides a "read more" button that I suppose will take you to the article. It is in the "Breaking News" section, as yellow rose indicates.

    The article pretty much confirms the emerging view that patients with aggressive tumors benefit from chemo, and patients with the more indolent ones are unlikely to benefit. Unfortunately, that doesn't help people with intermediate Oncotype scores make decisions about chemo. I suppose the good news is that the more we learn, the more we'll be able to target treatment to individual cases, but it's a slow process.

    In the meantime, I have to put up with people looking alarmed when I say I opted out of chemo, because there's a general assumption that chemo is good for everybody. That headline may well help people who need chemo decide to do it, which is good, but it may also make people who decline chemo for good reasons look like crackpots.

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  • Gitane
    Gitane Member Posts: 1,885
    edited December 2009

    To me this study, and some others show that there are good reasons to not do chemo.  This one is super interesting because these are women with node positive BC.  There are obviously many people who are hurt by the SEs and who gain no benefit.  I am encouraged to see that we are getting closer to finding out who benefits and who doesn't.

    On a personal note,  I wonder what drives my tumor.  It's considered "indolent" if that means low proliferation rate.  I had an s-phase fraction of .5, and am Her2 negative by FISH,  yet had an Oncotype score of 23. I thought at first it was because I was PR negative, or had low ER, but others with that have scores that are much lower than mine.  Worries me sometimes, but I'll never know.  I also had a good response to an antracycline, yet I keep reading that it works on TOPO2 amplified tumors, usually associated Her2 positive.  Geese, I don't fit anywhere with ILC, pleomorphic, and now this.  Oh, well.....

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