Oncotype Dx Test Anyone?

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  • QuinnCat
    QuinnCat Member Posts: 3,456
    edited January 2014

    At 100, you'd probably need it ;)

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  • NancyHB
    NancyHB Member Posts: 1,512
    edited January 2014

    Hi Kam! I always marvel at how very close our diagnoses are - almost down to the date. :-) Nice to see you again.  

    I am disappointed that I do not have my ki67 score in hand.  As I said earlier, I used the predictive model that MsP posted, inputting all the data I did have (including my Oncotype score) to work backwards and get my ki67 - and the only score that got me close to my final test results was a ki67 of 96.  I wonder - since it's one of the multiple tests Genomic runs, if they'd disclose the actual score to me if I called them?

    Grace - Oncotype score does not take into account a person's age when determining the outcome and risk.  The score is based solely on the genetic makeup of the tumor itself.  Oncologists do, however, often take age into account when determining treatment options. 

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  • cookiegal
    cookiegal Member Posts: 3,296
    edited January 2014

    Ms Pharaoh, my onc said the exact thing in your original post.

    A low oncotype cancer has less risk of mets, but if you get them, they are hard to treat.

    They may be slower moving, but chemo is not much help.

    If I remember correctly, on the node positive chart the women with low oncotypes but a lot of nodes don't have a great prognosis.

    (I hope I am explaining it right.)

    (Infact there is even part of the margin for error where low oncotype women have a higher mortality with chemo)

    I think the people who skip hormonals based on oncotype are not quite understanding it.

    The score is based on taking hormonals, and if you have a low score you typically have a high ER which means you should really benefit from them.

    I also think intuition plays a role here.

    I tried to live with the decision to do chemo, I was sort of planning on it, and something deep inside was saying no. 

    Go figure.

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  • lekker
    lekker Member Posts: 594
    edited January 2014

    When I picked up my OncotypeDX paperwork from my onc back in August 2012, I was disappointed that Genomic Health only discloses the ER, PR and Her2 portions of their analysis.  I called Genomic Health and spoke with a rather rude man who told me that the rest of the information that was used to calculate the recurrence score was their proprietary information and is not released.  When I said that they advertise the test as a 16 gene analysis but it seemed strange that they only tell the patient the result of 3, he shut me down and said that there was nothing he could do. I don't know if that's changed in the past year though.

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  • wyo
    wyo Member Posts: 541
    edited January 2014

    Looking at my genomic health oncotype report as I read all the posts today.  My RO asked if I wanted the test to tell her and she would order it- and did. 

    My recurrence score is 13 with an average rate of distant recurrence of 8% of course 6-11% for 95% confidence interval ( and who said stats was a big waste hahaha). 

    When you look at the graphs on page 2 with a recurrence score of <18 the absolute benefit of chemo at 10 years is about -1%- no benefit. In the scores >or equal to 31 there is a very clear benefit with a decreased rate of recurrence over 20%. 

    My recurrence score on the comparison chart of with/without chemo is almost identical- the tam and tam/chemo lines overlap.  

    No one on my treatment team sees any clinical benefit or increased prevention of recurrence by adding chemo to the mix- ER score 9.1 positive

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  • msmaples516
    msmaples516 Member Posts: 54
    edited January 2014

    hey I am jersey girl  too!! Moved to n.c. Six years ago.  Yes I had Octo type test my score was 14 low end so no chemo just radiation treatments 33 to be exact 10th one tomorrow.  You will be fine do what ever it takes to be we'll keep is posted I also started a journal that really helps a lot!! Take care

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  • Warrior_Woman
    Warrior_Woman Member Posts: 1,274
    edited January 2014

    Cookiegal - I just learned about 5 new things I did not know from your last post.  

    MsMaples - What are you doing with all the state tax money you save?  LOL

    Ladies - I agree.  We should have all the data Genomic produces.  I don't like the secretiveness at all.

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  • CaliKiwi
    CaliKiwi Member Posts: 98
    edited January 2014

    I've tried using the spreadsheet linked at the beginning of this thread to try and predict what my oncotype score might be. Since I haven't had surgery yet all I have is the info from my biopsy.  For those who have used this tool, or really, just have the results from their biopsy pathology and their surgery pathology - was their a large difference in your ER/PR percentage numbers? Trying to predict how accurate my receptor scores from my biopsy are.

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  • QuinnCat
    QuinnCat Member Posts: 3,456
    edited January 2014

    Hey Nancy!  Yes, we occupy our own special place on the bell curve, don't we?

    I just tried the tool now that I'm off the Iphone.   The spreadsheet model predicted an Oncotype score of 30, my actual is 39.  

    Ok, a little confused why Her2 included in the SS as the Genomic's cohort doesn't include Her2+.  I know some Her2's get the test because they are thought to be Her2- at the time test ordered and they do end up getting high scores, but is there any relevancy between the score and recurrence for these women?

    Also, something pesky with being low PR - worse than being low ER.  Probably the correlation with being luminal B.

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  • QuinnCat
    QuinnCat Member Posts: 3,456
    edited January 2014

    kiwi  -  my biopsy pathology was 90% ER and 5% PR  (IHC).  Edited to add:  A second look at slides gave me 95% ER and 1-2% PR.  I'm not looking at the genomics report, but my ER came out a bit more mediocre (middle of positive territory - I'm thinking 12  9.0 ) and my PR (5.7) correlated well, barely positive, the left side of the Confidence Interval falling in the negative territory.

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  • CaliKiwi
    CaliKiwi Member Posts: 98
    edited January 2014

    Thanks Kam, my ER is 11% and PR 4%.  I've been trying to figure out how accurate those scores will be, as well as if they will mean anything with regards to chemo.  I guess I should be more patient and just wait but... eh, I can't help trying to work through all the scenarios!

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  • QuinnCat
    QuinnCat Member Posts: 3,456
    edited January 2014

    When I've asked my MO about the discrepancy between my IHC for ER (high) and the Oncotype for ER (middling), she always told me the Oncotype test trumps.  In my case, I really liked the 90% ER (IHC) and kept hoping I'd get a different answer from her ;)  Nope.

    There was a discussion elsewhere on BCO, a year ago or so, where people discussed their own personal experiences with IHC versus Oncotype and I remember coming out of it more confused than ever as it appeared to correlate as much as it appeared not to.  Is this a measurement error or is it the nature of the tests?  The tests are definitely different (what and how) and perhaps what my MO was expressing was that nature of the test is more predictive rather than one testing process being more accurate, or even precise, than the other. 

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  • lekker
    lekker Member Posts: 594
    edited January 2014

    My ER and PR were both 90-95%+ from my biopsy but my oncotype showed a slightly lower ER by their measurement.  The definition of Her2+ Is 3+ By IHC for determining the use of Herceptin (although there are trials going on looking at whether or not Her2 "low" would also benefit) but the oncotype looks to see if there's any expression of Her2 as a measure of aggressiveness.  Even though my ER was lower than expected and my Her2 score was higher, my overall score was 13 - I think because my PR was so high. No one really understands the relevance of PR in all of this yet.

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  • QuinnCat
    QuinnCat Member Posts: 3,456
    edited January 2014

    I need to look at my report - was her2 measured by genomics?  Ok, pulled the report out....

    I previously disregarded the Her2neu factor since FISH test did.  I was Her2 +2 equivocal.  Geonomics had me at 7.9 negative.

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  • cookiegal
    cookiegal Member Posts: 3,296
    edited January 2014

    If someone could post the graph, it would be really helpful for the gals who don't have their report yet.

    The study for node pos is swog-8814.

    There are a lot of articles written since 09 I never read interpreting that info.

    More to come in 2016.

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  • Warrior_Woman
    Warrior_Woman Member Posts: 1,274
    edited January 2014

    Well, my Oncotype is 24 and I'm doing chemo.  The odd part is that my first 2 path reports said 70% and 90% ER positive.  The Oncotype report came back ER negative.  It's highly unusual and odd given that I am very PR +.  But since I cannot rely as much on the hormonal treatment, the decision for chemo is a no brainer.  You women are wonderful.  I've been so frightened but it is easier now with a decision made and your support has made a great difference.  Thank you!

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  • CaliKiwi
    CaliKiwi Member Posts: 98
    edited January 2014

    Warrior_woman, I'm sorry that you have to go through chemo but at least now you know what your strategy is and can start planning for that.  Thank you for starting this thread, I have found it very helpful for me as someone just starting on the journey, knowing I need to take this test.

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  • paloverde
    paloverde Member Posts: 179
    edited January 2014

    W_W, so sorry, I know it's not what you had hoped.  Please feel welcome to join us in the Jan 2014 chemo forum.

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  • MsPharoah
    MsPharoah Member Posts: 1,034
    edited January 2014

    WW,  I know that you were hoping for a lower score. So very sorry you were disappointed.  As I told you, once you make this decision, $hit starts to fall into place.  You are killing cancer...remember that.  Join the January 2014 chemo thread... It is so helpful to have some friends to support you.  And if you ever need anything, feel free to pm me. 

    Love, MsP

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  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited January 2014

    Sorry WW. Gentle hug. 

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  • Warrior_Woman
    Warrior_Woman Member Posts: 1,274
    edited January 2014

    Thanks everyone.  I am fine.  The very worst would have been to decide against chemo and be left wondering.  Heading to the January Chemo thread!

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  • paloverde
    paloverde Member Posts: 179
    edited January 2014

    WW, I skimmed your post last night on my phone but didn't read it closely until this morning on the computer.  

    Did you say your original path reports stated strongly ER-positive but your Oncotype came back ER-negative?  What did your MO have to say about that - I think someone else on these boards said the Oncotype trumps the IHC?  That's so fundamental to treatment decisions and especially prognosis, so since I didn't have Oncotype and therefore don't have a second measurement, that's making me a little paranoid.  

    On the other hand I think you said there were some questions about the quality of results from your original pathology work? 

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  • Warrior_Woman
    Warrior_Woman Member Posts: 1,274
    edited January 2014

    Paloverde - One onc said he's never seen anyone go from 2 path reports stating highly ER+ to an Onc report saying ER-.  The one oncologist said he's never seen that before.  My surgeon said the tests for ER are measured differently.  I am getting another opinion from someone who has significant knowledge of this.  My fear is that with a score of 24 and if I am ER- that neither chemo or Tamoxifen will help greatly.  My original 2 path reports had minor differences but nothing significant like this.  Right now, it mean chemo because I may not get as much benefit from the Tamoxifen.  Ugh.

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  • encyclias
    encyclias Member Posts: 302
    edited January 2014

    Warrior, it's been found that chemo works especially well on ER- breast cancer, better than it does on ER+.

    Carol

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  • Warrior_Woman
    Warrior_Woman Member Posts: 1,274
    edited January 2014

    That's a relief, Carol.  Thank you for posting the information.  I also have ki67 40% and understand it responds well to chemo too.

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited January 2014

    Warrior... IMHO... I would ask the oncologist to follow up with the pathologists and Genomics Inc and ask why the results were so divergent.  I've heard of differences but that difference is way too different.  You need to verify whether or not you are ER +.  I wonder if Genomics was looking at the wrong specimen....

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  • Warrior_Woman
    Warrior_Woman Member Posts: 1,274
    edited January 2014

    Thanks Voraciousre - The Onc said they'll retest the samples they have.  I do have an appointment with someone next week who should be able to help me sort this out.

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  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited January 2014

    Does anyone know how to correlate the oncotype dx ER/PR scores to the original path %? Genomic says for mine ER=10, PR= 9.8. Path says ER 94%, PR 97%.

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  • Warrior_Woman
    Warrior_Woman Member Posts: 1,274
    edited January 2014

    Lucy - They do use different measurements / scales.  In all your measures you are strongly ER/PR positive.  They also use different testing methods.  My Onc just told me the Tamoxifen should benefit me as the studies with Tamoxifen effectiveness measured ER receptors the same way my original path reports measured it.  

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  • cookiegal
    cookiegal Member Posts: 3,296
    edited January 2014

    Warrior Woman, it all makes a little more sense now. Good Luck!!!

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