Oncotype of 18 - chemo or not?

Hi Mom - I am no expert on this but I wanted to reach out so as you know you are not alone. There has been a lot of discussion on this recently because of the Tailorx trial, they are trying to find the cut off of where chemo is not effective; they released results for the lower numbers but little is forthcoming with the intermediate numbers, right now although all signs point to hormonal's being effective with intermediate scores too. 18 is at the very end of the intermediate range as I am sure you know - that number sucks! I am so sorry. Things that I would weigh by myself:

What were your ER/PR + percentages? Was your Ki67 relatively high? What does your Oncologist say?

Mine told me no chemo with a score under 20, but no two Dr's seem to have the same opinions so it comes down to what you personally want to do and what your oncologist thinks - what is the net benefit, are you willing to run the risks of chemo for a 1 -2n or 3% gain? I know there is someone on the boards here (there are plenty more than one but this is the only one that comes to my mind right) under the name: Meow13, she declined chemo with an onco score of 34 - I *think* she is coming up on 5 years cancer free, perhaps even more?

It is tough and I think everyone regardless of chemo, stage etc second guesses themselves, but the chance of recurrence are on your side, chances are you won't get one whichever route you take, it is just not guaranteed.....but what in life is?

Hugs and best wishes.

Laura x

Thanks Mods, posting from my phone wasn't letting me link that in....I planned to edit when I got home. Glad you beat me to it

This is a tough one. The thing is, there are no guarantees either way. Putting too much emphasis on the Oncotype score may not be that productive, as the results come back as a percentage of risk, and there are people in that percentage, no matter how small, who recur. No one knows who they will be.

I would have a heart-to-heart with your trusted oncologist and probably go with his or her recommendation unless you feel you feel strongly one way or the other. Unfortunately, our oncs are not gods and can only make recommendations based on their experience and research. You need to do what feels right for you. Figuring that out is a headache, I know.

Are you highly ER+? Tamoxifen is a pretty effective drug. Even women with Stage IV are being given Tamox and the AIs to control their cancer. On the other hand, if you're in the "want to do everything possible" camp, a round of chemo may put your mind at ease. They are much more tolerable these days, and have fewer side effects than the drugs of old. But even that will not guarantee no recurrence.

Good luck.

Grade 1 tumours are the least responsive to chemo. As Englishmummy and others have asked above, what are your ER+/PR+ %s and Ki-67? Tamoxifen will provide a greater benefit to you as a systemic treatment, particularly if you are fairly high ER+. Well differentiated tumours (grade 1) tend to have a low proliferation index as demonstrated by a low Ki-67 value, so there is usually good correlation. Check the breakdown of the three components comprising your grade score (tubule formation, nuclear pleomorphism and mitotic count). A '1' for mitotic count would indicate very low likelihood of response to chemo. With a grade 1 T1c tumour, negative nodes, hormonally positive, unless your docs have compelling rationale for you to do chemo, I don't think the benefit outweighs the risks. Best wishes making your decision.

I didn't have cording myself, but it usually resolves on its own over time. PT exercises and stretching will expedite this. If yours is limited to your armpit area (doesn't extend to your hand, or even elbow), it will usually resolve sooner. Keep working on the stretching. After you experienced the infection and leaking, I know it's just one more frustrating thing you have to deal with, but you'll get there! Hugs

Hi, My score was also 23. Any lower I would not have done chemo as my % of benefit is 5-6%. My ER from pathology was just 25%. This is a very personal decision. There are some great oncotype discussion threads which really helped me weigh the risks and benefits.