Another Oncotype question

Chachamom, since you're HER2+ are you not having Herceptin? I thought that was a given for HER2+ BC?

So I got my stats from onc today at 3rd chemo of 4. ER 30%, PR 0%, K167 43%, oncotype 38. I had seen them at the beginning but didn't have a copy. given what you all seem have heard, does that exPlain why chemo was so strongly recommended? Remember the oncotype had my ER "negative" at 5%.

Thanks for any thoughts!

Even 30% isn't very high for the ER numbers. Both my ER and PR are in the high 90's.  What that means for you, as I understand it, is that you are less likely to see as much benifit from the anti hormonals

Cindy - is this true? When I've asked my MO about my mediocre ER status, though still positive, they all say "it doesn't matter."  I always got the sense it was like being pregnant or not.   Then again Oncoscoring does give is more points the higher the score is (actually less, as it substracts from the final total oncotype score), maybe they're not giving me the correct picture?

btw, my Oncoscore for ER was 9.0...mediocre, but my initial path said 90%.  I've always interpreted this as 90% of the sampled cells have estrogen receptors, but their reactivity was a 9.0...which is sort of middling on Myriad's scale.  Am I wrong about this? 

Yeah I think the oncotype reading for ER 9.0 = 90% mine is a solid 10.0

 It's not that you'll get no benefit from the anti-hormonals (going from my best recollection of what the MO said) but he said the higher the number the more benefit I'd see.  So I would assume the opposite is true, the lower the number,  the less need for anti-hormonals, but that is just based on what I thought he was saying.   Probably best to follow up with someone who actually understands this stuff.

 Of course to complicate things, it's also my understanding that with a large tumor, a sample from one area might have a very different pathology than a sample from a different area.  It's all very confusing.

Well, my tumor was small' barely 8mm. So there might not have been variation- though they couldn't get it from the biopsy,they had to send again for a bit of the surgically removed tumor. Needed more RDA or something.. Made it take an extra 2weeks for results!! And 0% PR ..So maybe I am weakly ER positive. Glad I am doing chemo though it stinks.

Think my Onc said even if you are low positive ER he believes that i derive benefit from anti hormonal. I guess when I get to that point, we'll see, and if I don't like the side effects, I'll discuss the options. My cousin ( same age, had BC last year) is triple negative. At least I have a bit if hormones!! Sometimes this seems like such a game of odds, you can have it "understood" and can get knocked sideways. Sure good to have this little group that is equally interested in this question.

You have to ask your surgeon or MO to order the test for you.  As a rough rule of thumb, it seems that high ER/PR, together with low grade and low Ki67 generally correlates with a low score unless you're HER2+. 

Mary - where are you getting this conversion to 23%??  I've had this question from the beginning...how does the Percentage listed in my intial biopsy relate to the score in my Oncotype test?   As I've said, I'm "90% ER" on the initial pathology, but 9.0 ER on the Oncotype.  I see no percentages listed on the Oncotype.  After 6 months of not really knowing the true answer I've interpreted (or gleaned without remembering the source) the 90% as the amount of sample that has ER receptors and the 9.0 Score as how receptive the cells are (and I don't know how that would be measured, so that's just an idea thrown at the wall).

Well we certainly have 2 contradictory ideas.  One of us could be right or we both could be wrong.

This was discussed awhile back on another thread. Here's what I remember. The pathology report is subjective & is given in a percentage by a pathologist. The oncotype is quantitative & has a number assigned to it. There were some women who's MO ordered oncotype done on tumors with no or low ER per pathology. If it came back positve they would benefit from Tamoxifen. My tumor was 99% on pathology & 9._ on oncoscore. I thought I should be up around 12. Wish I could remember the older thread or the poster who explained this much better than I can.

From what I've read, any ER% is ER+ and is responsive to Tamoxifen.  The Oncotype score will give you your ER/PR percentages and, I think, your Ki67.  I would ask my MO to order the Oncotype test.  It will tell you if chemo will be of any benefit to you.

Otter gave a great explanation earlier in this thread of Oncotype scores...on page 2, look for her posts April 25th.

PLJ "I was highly ER+ on both tests, but, PR- on IHC while highly PR+ on Oncotype." 

This makes it even more mysterious as I was highly ER+ on first path, mediocre on Onco.  PR 5% on first path, low on Onco.  Our individual correlations from path to Onco aren't even in synch and the measurements from path to Onco are positive in one case, inverse in another.  (Hope you get what I mean).  These measurements (path vs Onco) seem to be measuring totally different things if this is the case.

I spoke with one of their techs last year (had several conversations actually) and asked about the relation of IHC % to Oncotype dx scores. I was told that the Oncotype scores have not been validated to correspond with IHC staining because they measure different things. You can read about the formula to understand what is measured but their results have only been studied to correlate with RS. Because they measure very different aspects of a tumour, along with the fact that tumours are heterogeneous, you can't seek to make a connection. Just like different slices will perhaps stain differently, thereby yielding various % staining, the intracellular mRNA evaluated in Oncotype dx may yield a different result to pathology report. Again, because the means of recording a score is unique to Oncotype Dx, there is no scale to translate this number to correspond with pathology. Apples and oranges.

Kam170: It is my understanding that if both IHC and Oncotype come back with positive scores for a particular receptor, then the receptor should be functioning. However, if one is positive and the other negative, then it is questionable whether the receptor would actually function as it should.

Yes, totally natural Cindyl. When I got my RS last year, I wanted to know *everything* about the report! I particularly wanted to know why my PR was highly + on Oncotype Dx but - on pathology. Several conversations and pages of questions answered later, I was satisfied!

When ER is highly +, along with a low mitotic rate (or ki67), you get your biggest bang out of hormonal therapy and chemo is typically a less efficient means of cell death. Of course other things like nodal status, grade, size, histology, Her2 and LVI are also taken into consideration when contemplating the big chemo question. It is my understanding that the ER, PR and ki67 scores are given considerable weight in the Oncotype Dx formula. Had my Oncotype Dx PR come back -, I'll bet my RS score would have pushed me into the intermediate range and chemo would have been recommended. It would be nice if Genomic gave a complete print out for all of the genes evaluated. It is frustrating to have some of your personal health information kept in secrecy.