Question about the "intermediate range" on OncotypeDX

Curveball, strange.

Hi all,

I need some help and opinions, please......I went to my oncologist today. She had predicted a low oncotype and just tamoxefin therapy. I'd already picked it up at the pharmacy! Well, it was not as low as she hoped. It was 18. She has given me three choices.

1) take tamoxefin only and have an 11% reoccurrence rate to stage 4

2) do 4 cycles of TC chemo to reduce the reoccurrence rate to 7%

3) get monthly shots in my stomach to suppress my ovaries and put me in menopause, begin me on tamox and switch me to an AI. She said this would also reduce my reoccurrence rate to 7%.



A big thing is that I had 5 tumors, 3 around 2 cm. My oncologist says things would be simpler if I had only had one. My age, 48, is also a factor.



I have no idea what to do. Does anyone have advise or insight? She would like me to begin next week.



Thanks in advance. It's been an unexpected day.

My score came in at 16. My MO was on the fence about chemo, too. But, given my "young" age (43) and the fact that my tumor (one) was just over 4 cm....she recommended 4TC. I'm glad I did it. I just had a hysterectomy, too, and feel good about it.

Michelle - I live in Australia and had to pay $4,000 for the test!



I only wanted chemo if it was a strong benefit and this was going to help me make the decision. My score was 18 and with just one lump and one micro met in my lymph nodes I decided no chemo. I think the result was of more benefit to my Oncologist than me.... it made her "feel comfortable" with my decision.



This is a very personal decision but once made allows you to move on.



Best wishes to everyone.

Lmimpo64, I would say to first go to cancermath.  You can find it at www.lifemath.net/cancer/breastcancer/therapy/index.php.  Specifically look at the therapy link where you can input your information with and without treatment to see the percentages.  I plugged in your numbers and it shows your risk with doing nothing is 7.3%.  Tamoxifen alone brings you to 5%.  Chemotherapy alone brings you to 3.3% and a combination gets you at 2.2%.  There are many of us who have gone though treatment because AFTER we did it, we brought ourselves down to the 7%.

I had a small tumor, lumpectomy, but  had 2 micomets in the nodes.  I also had a 22 oncotype.  If the micromets weren't there, I would have gladly skipped chemo.  Some even say that micromets don't count as positive, but since I was at a 22, I decided to do it.  If my nodes were clear, I would have went right to radiation.

The flip side now is that I couldn't take Tamoxifen.  This is something I would have never known ahead of time.  Tamoxifen had me jumping out of my skin and mind.  My gyn tested my hormone levels and I am now considered post-menopausal so the chemo brought it on perhaps 5 years earlier then it would have been.  The surgery, chemo and radiation aged me more than I ever thought.  I was the picture of health before this began.  Each treatment wears on you and the combinations can be rough.  Not always while you are going through it, but once everything is said and done.  So, you asked for opinions... there you go :-).

Hi all, I don't post often but this is near and dear to me. I was all set after the initial biopsy to go for internal radiation 5 days x2 per day, take tamoxifen and be ready to move on...because I had a rarer type of idc (mucinous) my surgeon ordered an MRI. results came back with two microscopic satellite rumors within the same quadrant. That took the short internal radiation off the table and opened up the possibility of chemo. The radiologist placed three wires so the surgeon could take out all three tumors...guess what, the two satellites were b9. However the real tumor was nestled in against the chest wall. The surgeon assured us that it had not breached the chest wall and was easily removed entirely. She was very confident that if she missed anything the radiation would take care of it. In my mind yippee, I don't have to convince anyone that I don't want chemo! Wrong, I did my mo consult and the first thing he suggested was...chemo. I reminded him of my favorable mucinous type and the fact that it had a very slow k67 8% nuclear and mitotic grade were also low...we finally agreed that we would let the onco test decide. I agreed that if it cam in in the grey area, was intermediate or high, that I would do the chemo. I went to the beauty salon and had my hair cut really short...I knew I was having chemo! Three weeks later when the results came back the mo seemed very hesitant to give me the results, I thought I had like an 80 or something, well turns out I got a score of 8. Mo saiid he would have a difficult time even recommending it with that score. He didn't have any trouble contacting the RO immediately and pushed for max radiation...I was so happy not to have the chemo that I was the most compliant patient. So I am on tx 20 out of 34 today. I will start tamoxifen after radiation for 2.5 years to build up bones then switch to AI for the rest. Rads are not easy, but not having chemo makes them much easier to handle. Good luck to all as you make your choices. Whatever you choose will be the right thing for you!

Definitely get second opinions... even third if that is what it takes.  I went to two different MOs.  One wanted to do TACx6 and the other said TCx4.  I also sent my pathology slides to Johns Hopkins for a second opinion on the tumor itself.  There were minor differences with those opinions, but it helped me feel more confident in my decision.

You said, "A big thing is that I had 5 tumors, 3 around 2 cm. My oncologist says things would be simpler if I had only had one."

I thought that would make you an IDC, 6cm (or something like that).  That changes things a bit.  I only had a 1.2cm IDC.  What you mention above would put you in a different boat.  Sorry if I didn't see that clearly the other night :-).  Please find out what it means or maybe someone will chime in on multiple masses.

I was 45 when diagnosed with synchronous BC. Largest tumor was 1.3cm and other side DCIS. Grade 2. 0/2 nodes. Oncotype DX 19. I opted out of chemo and rads for BMX and 2.5 years of Tamoxifen followed by AI. Two MO's stated they would not do chemo in my case. I was >95% ER/PR +. I am 50 lbs overweight so dietician also recommends mostly plant based diet and avoid plastics and styrofoam, etc to minimize estrogens. I had ooph 4 years before CA dx. Hope this helps. Good luck on decision making. It's not easy, that's for sure. I also think that I may be reserving chemo for later if needed.

Hello ladies:

Met with a med onc today and discussed next steps post surgery and internal radiation. We discussed my OncotypeDx results and he said with no further treatment, I am at a 15% distant reoccurrence rate with a score of 23. He is recommending the aromatase inhibitors and said that would bring me down to 10%. Chemo would only drop my risk 3% more. Felt like a relief that the numbers were not higher. I can live with the 10% with doing just the anti-hormone meds.

I have one more med onc consult to do in my city (this was done out of state where I am getting my internal rad done). Will be interested to know more about his/her take on my pathology and genetic panel info. I think the decision will now be more about which anti-hormone meds to take and for how long.

Edwards750.........I was surprised too. I guess out of the 21 genes they tested some aren't ER+ and those are the ones that caused my high score. It's quite confusing. I guess the cancer cells that aren't fed by estrogen are the ones my MO wanted me to have chemo for.

atanea,

The Oncotype score factors in Ki67, but doesn't report it separately.  

Hi Curlye-

Like yourself, I had an oncotype score of 25, grade 2,  with multi-focal disease....(2 tumors about 2.8 cm total).   I had neoadjuvant chemotherapy which consisted of taxotere and cytoxan for six treatments.  After chemo, I opted for a BMX for various reasons.  My oncologist and I had a discussion before the results came in that if I was in the intermediate range, she felt that chemotherapy should be part of the treatment plan because of my age, which was 42.   While it wasn't easy, it was very doable.   There  are many things to take into consideration, and I think your age is definitely a factor.  That is great that you had negative nodes, so I would think oncologists would take that into consideration when  recommending the type of chemo regimen.....I think that TC X 4 would be suitable.  Another option is ovarian supression.  Some docs are now saying that ovarian supression plus Tamoxifen is just as good, if not better than chemotherapy for early stage, ER/PR positive women.   You definitely should have a second and maybe even a third opinion to ease your mind.  If I can answer any other questions, please don't hesitate to ask.   There is a TON of information on these boards regarding this subject.   I used to say often "I'm 42, I have a long life ahead of me, which also means I have a long time for cancer to recur.....I didn't want to take any chances, but that was me.   Please talk to your MO about ovarian supression option.  Its definitely something to think about in your case? 

Hi Curly,

Sorry to hear about your diagnosis! My score was also 25 and as my signature below shows, i had Grade 2, 2 cm IDC.

I was really not in favor of getting chemo but I did seek out a second and even third opinion. The more I learned, the more I felt that I needed to do it.

You have a grade 3 tumor which means it grows quickly and could respond to chemo well. In my case, my tumor is highly ER positive but PR negative So there is some research that suggests that I might not get as much out of hormone therapy with PR negative.

In Any event, I was 50 at diagnosis with two young children, so I felt that I needed to throw everything at it.

I'm coming up on three years out now, I feel great and I'm very glad I did it.

I wish you peace whatever you decide and best of luck. Best, Beau

All the best to you Curly.....Personally, I think you're making a good decision......You are young and will bounce back in no time!

Doing well!  The only thing I complain about on a regular basis is a 10 lb. weight gain since my diagnosis and some aching joints in the morning, but that's it!