Oncotest Scores

wonderwoman and dianarose, I found the oncotype DX website to be very helpful.  There's a lot of good information out there, especially under the healthcare professional section.  They say grade does not correlate with the oncotype DX.  So it comes down to if you put your trust in the oncotype. 

Wonderwoman I think if I had gotten that reply from the Cedars pathologist and oncologist, I would be able to rest easy with no chemo.  But I would never make someone else's decision.  Do your research and go with your gut.  My center is a big believer in oncotype score.  I was a 16 and there was no discussion of chemo being a good idea.  I decided to go with the numbers and do my best to exercise, which is also supposed to reduce recurrance and be healthy.  In my mind, it doesn't mean I have no chance of recurrance, it means the chemo wouldn't offer much more benefit in reducing my chance of a recurrance.    

Dianarose, what a dilemma! I have the same oncotype scorew w/no + nodes. I would be very nervous about no chemo with 17+ nodes. I see you had 2 tumors IDC & ILC. Did they test both?

Diana Rose....the only thing I can think of is parp inhibitors, which are still in trial, but in a case like yours, perhaps worth a shot. 

You are right that the low oncotype women with a lot of nodes did not really get much of a benefit from chemo. Especially with the ILC, which tends to be low oncotype.

Wonder, it sounds like things are lining up for you!

I'm wondering about the ki67 too. I think I understand what it is, but I don't think my Oncotype report has the information. It was 4 pages long and only has my score (15, recurrence risk 9%), charts for negative node and positive node, and then bar graphs on the last page for ER, PR & HER2. Is there a longer report I should be asking for? (I couldn't find it on the pathology report either after searching both the biopsy path report and the surgical path report.)

Hi, Linda. Yes, the numbers are similar. I haven't even met with the RO yet though (May 8), so I don't know when I'll actually get this show on the road. There have been several delays, but this cancer is slow growing, so I'm going to outlive it (and any of its little squatter relatives).

First there was discussion between the MO and the SO (and even the local tumor board!) about whether to do neoadjuvant therapy or start with surgery. The SO won that one because there wasn't a lot to have to shrink first (1.5 cm lump) and we already knew there was at least one met to the nodes. She removed all the axillary nodes to be certain, so that's taken a while to heal.

Next I developed an axillary staph infection 5 days post-op that didn't respond to oral antibiotics, so back in the hospital for 4 more days.

And then when the Oncotype came back low and only a 9% RR with 1-2% relative change, both the SO and MO said, "Let's throw all our weight behind hormonal therapy. That'll be a bigger systemic punch than chemo would be." So I'll be on Femara generic for 5 years.

Theoretically I'll be able to skip radiation to the underarm and "just" have whole breast radiation. I'm looking forward to learning the RO's plan. I don't know how long it'll take to get all the measurements and then the simulation. Meanwhile I'm working on my range of motion exercises for my armpit -- that sounds really odd, doesn't it?  The idea of holding my arm over my head for any length of time gives me cold sweats.

Ah well, nothing has changed my conviction of a positive outcome. I just wish I could get on with it!

Wonderwoman....In your heart...tell us, what is your decision? No matter what the opinions...what have you concluded?

Hi Linda,

This is interesting. I applaud you for being so adament. I wasn't. I said 'get me the juice...and let me get the hell out of here'.

It's doable....helpful hints? Drink lots of water and let the stuff run through you fast. Don't be afraid to take those nausea drugs even if you feel ok. Good luck and you're in my prayers.

I've been following your story wonderwoman.  It sounds like your MO's were so responsive and thorough, following up on your concerns.  Personally I think you made the right choice to do chemo with Grade 3, despite the oncotype score and it turns out your issues matched some things I read about different parts of the tumor being of different grades.

Is the "T" Taxotere or Taxol? Overall, it sounds like a light regimen...I just finished my 6th chemo dose dense (Adrimaycin/Cytoxin and now Taxol).  I think Adriamycin is much harsher than others, but I have to say, very doable.  If they give you Emmend, it really does control the nausea.

Timbuktu...I guess I"m a little surprised that you had that long of chemo. I would have thought it would be 4 times and rads. It sure tells us Drs. are all different in their opinions.

Artzee I am in somewhat the same staging and grading as you.  I had te onco test and came out at 22 (gray area)  I am 66 and moderate health and weight problems.  My dr has said chemo would not benefit me that much and doesn't feel with my other issues I should take it.  Did you have chemo

@artsee CMF is a milder chemo...and older one as well, but it takes more treatments. (Sometimes they do it dose dense) At MSK they tend to use it for borderline cases.

On Wisconsin, BTW, I love that state! 

Thanks SpecialK for posting that link.

Do you know what the low-hi range is for the Ki67 scores that determine if its a Luminal A or B?

Wow, this is all so interesting.  I have an Oncotype score of 13, recurrence chance 8%, but I also have 3 positive nodes which have sizable cancer in them, but not broken through.  The Adjuvant test was a little more gloomy, but they test different things.  If only there were reliable study results with the Oncotype testing for women in my situation with positive nodes, but there really aren't any large studies yet.  Understandably, few want to enroll and take the chance of getting chemo when it might not benefit and might harm and their docs aren't encouraging them to enroll.  I think there is a newer study happening now that will help somebody in the future.  My MO said I was in a gray area, the RO said to do both rads and chemo, and I was left to decide.  I did not know about Lumina or Ki67 scores.  I decided to do CMF, starting Friday. 12 weekly, 6 weeks of rads, then 12 weekly again.  Weekly because the SE's may be less.  Interesting note, since I had extended morning sickness with all three of my girls, my chances of being nauseous with chemo go way up.  Give me anti-emetics, please.  My MO says I can stop the CMF if it's too much, that's how unsure we are of the benefit.  But I decided to give it a try, think of it as a little less time than a pregnancy, my temporary job, whatever.  At least I'll know I gave it a shot.  Of course, after reading all this, I am wondering if putting off Tamoxifen/AIs is such a good idea.  Ultimately, I am putting a large amount of trust in my MO, who I think is capable and knowledgeable.  I go to a cancer center in Seattle where a lot of research happens and I know she is up on all the studies, worldwide.  I will ask her about the Lumina and Ki67, though.  Sometimes the docs just don't know how much info patients want.  I want a lot.  My treatment plan isn't written in stone.

God bless all of you, those who have made decisions and moved on and those in the middle of the decision-making process.  No looking back. 

WonderWoman,

Hope you're feeling better!

I just saw your link to the Oncotype webpage. I didn't know they had predictors for node-positive tumors in post-menopausal women. The report given me did not include that. Another thing to ask my MO about! Thanks.