Anyone with very high Ki67, Grade 3, Low OncotypeDx, no chemo?

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  • toomuch
    toomuch Member Posts: 901
    edited February 2014

    I'm so sorry that I didn't see that my link didn't work until now. Here it is again:

    http://ijs.sagepub.com/content/17/4/303.short

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  • WifeWBC
    WifeWBC Member Posts: 53
    edited February 2014

    Attention to initial poster.

    My wife diagnosed with similar markers to the OP's sister

    Initially we were optimistic about her prognosis given that ER positive is treatable with endocrines.  We were willing to pay for Oncotype DX testing, since her node positive is not covered here in Canada.

    Have since learned that there are subtypes to ER positive cancer which include luminal A & B.  That the latter is typically characterized by a high KI67 number (can someone verify this?).  That even though ER + , these cancers exhibit triple negative tendency.   Further, that these cancers (luminal B subtype) are tyically not responsive to endocrine therapies.  Since the Oncotype DX score assumes a course of endocrine therapy of 5 years, I wonder the value of the RS score if infact my wife does not respond to endocrine therapy.  In the absence of any real statisitcs (specific to Luminal B Cancers), and given my wife's age, we're thinking that, even with a low Onco DX score, we'd probably still opt for a full regimen of treatment (Chemo, endocrine and Radiation) - as has been proposed. 

    Essentially, why bother getting the test if it migh provide a false low RS for Luminal B type cancer.  Can someone commen on this train of thinking as, at this point, it is purely conjecture on our part.  Are there any members or moderators on here with experience in such matters?

    Thanks Everyone - my first post - on behalf of my wife

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  • Annette_U
    Annette_U Member Posts: 111
    edited December 2014

    Well this KI-67 has me a little confused. Mine was 63, but my ILC was ER/PR positive 100% and a grade 1, no nodes. I had chemo before mastectomy and mass was 4cm x 3cm x 1cm at removal. It seems odd to me that you could have a grade 1 cancer and such a high KI-67. With chemo first - I'm not sure is my cancer was over 6cm like the 1st MRI said or if it was even larger and shrunk with the chemo treatments. Maybe it was never 4cm because the PET and CAT scans could not pick=up any mass after 2 treatments but still there was 4cm at surgery. I did have multifocal - in lobules all over left side and a few large (1.5 -3cm) negative lymph nodes. It will be very interesting to see if they can figure out exactly how KI-67 predates prognosis in the future. I am out only 2 years so I'll be watching and hope I don't have to let you know any bad news in the future.

    So , if anyone can suggest any other tests I could have - I never got the Oncotype test - I'll bring them up with my ONC. I am going to ask her to put me on letrazole since it's been found to be a better treatment for ILC after menopause (which my Gyn tested last month and at 52 am happily there).

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  • greatjourney
    greatjourney Member Posts: 12
    edited December 2014

    Dear Geezer and friends,

    I hope you can help me too.

    I had double mastectomy last week December 3, 2014 and doing very well. My appointment will be next week so I'm so anxious to know what is ahead of me. Initial prognosis after the surgery as follows:

    1. Left breast very clear, no sign of cancer which is consistent with image tests.

    2. Right breast has IDC 4.6cm quandrant as per MRI but other test such as ultrasound and mammo 2.6CM.

    3. Did double mastectomy which is my preference to eliminate any future risks

    4. ER/PR Positive (Strong) and HER2-

    5. After surgery sentinel nodes were removed 3 of them, the first or borderline node was positive but the two nodes were negative; further, due to this outcome, Doctor remove 22 axillary lympnodes which were found to be all negative.

    My question is, is this a good prognosis, serious and do I expect chemo or radiation along the way.

    I will share the complete pathology report after my meeting with my breast oncologist doctor.

    Thanks and regards

     

     


     

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  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited December 2014

    Just to throw a little more info into the mix:

    I am very strongly ER/PR+ (100% & 88%) and HER2-, with a relatively high Ki-67 (43) on original biopsy and one confirmed node + on biopsy. My MO has said all along, however, that we WOULD do Oncotype before making any decisions about chemo. My tumor is not that large - it's the node that bumps me into Stage II. (Grade 2) Nonetheless, it has some pretty aggressive characteristics, unfortunately.

    I am shadowing a trial with neoadjuvant Femara, which in 5 weeks brought the proliferation rate down to 4%. US also shows sharp decline in the size of both the node and the tumor. I will continue this treatment for another 4 months before surgery, with the hope of completely clearing the node prior to surgery. If this occurs, no chemo will be under discussion. If there are malignant cells left in the nodes at that point, we will do Oncotype and discuss. Based on the strong response to Femara, I'll continue on it for 5-10 years, which I have no objections to.

    I think it's important for node+ women to know there are options, as well as opening up the conversation about neoadjuvant AIs. I'm really happy to have the information IN ADVANCE about how this particular tumor responds to it, rather than taking it on blind faith/hope that it will do some good. This approach is not widely offered in the US but is fairly common in both Europe and the UK.


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  • greatjourney
    greatjourney Member Posts: 12
    edited December 2014


    Hi Hopeful,

    Appreciate your inputs and will make further research about the neoadjuvant Als. However, in my situation where surgery transpired and lymph nodes were removed, do you think this will still be relevant in my case?

    Thanks for taking time to share your thoughts.

    Best and hugs,

    Mariz

     

    Appreciate your inputs.

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  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited December 2014

    Dear Mariz - no, sorry, it might have been helpful for you prior to surgery as your diagnosis is very similar to mine; I posted it for the benefit of other women who might read this. I wish more women were familiar with this approach!

    It's hard to predict what course of treatment will be recommended for you. A lot may depend on the results of your Oncotype testing, assuming you had that done.

    It is hard not knowing what's ahead and when it will be scheduled. And there's SO much of that with breast cancer - more so than some other types of cancer.

    Hang in there, Mariz, and do keep us updated. Take care!


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