Oncotype Dx for Node Positive

Matic--I appreciate your concern for me and your taking the time to write this thoughtful post.

I know that Adriamycin is a potent anti-cancer drug and that it is effective against some tumors. I have come across several studies that found it ineffective against lobular. One of the most detailed of these is a German trial of the effect of neoadjuvant chemotherapy on breast conservation surgery.  Whereas ductal tumors had a pCR of 12.8%, lobular tumors had a pCR of only 4.8 %. See http://www.annalssurgicaloncology.org/cgi/content/full/13/11/1434?ck=nck. In other studies the response rate was even lower, i.e. 1%. So some ILC respond to anthracyclines, but most don't. This may be partly due to most of ILC being HER2 negative, but some negatives do respond to Adriamycin.

I know the study of TC versus AC is not definitive as to which is superior (if either). Another study is in progress which supposedly will answer this question.  But TC is now being widely used instead of AC because of the cardiotoxic potential of Adriamycin, which is my main objection to it. The small chance of benefiting from Adriamycin doesn't seem to me worth taking if there is even a small cardiac risk.

According to what I've read, in terms of overall survival,lobular tends to do as well as, or slightly better than, tumor types which respond better to chemo. So it must have properties which we don't know about yet that produce these effects. Of course there are always exceptions. As I see it, nothing is guaranteed in this game, including chemo and Oncotype DX prognosis.