Ki67 and Oncotype

Cold capping was briefly mentioned by my oncologist but certainly not encouraged. I was told that I would need to bring and store my own dry ice. I was told that it would cause headaches and be uncomfortable. I was also told that I might not even lose my hair since it was so thick and I only needed 4 cycles of chemotherapy. I lost my hair within 2 weeks of the first treatment. I was assured by my oncologist that the hair loss would be only temporary. Honestly, had i known that taxotere could cause permanent hair loss I would have asked for a different chemo combination. I am now really nervous and praying that my hair will grow back.

I cold capped and it really wasn't bad! It was only uncomfortable for about 10 minutes each time. My doc discouraged it, told me it wouldn't work, and.... it worked like a charm! I have a full head of hair! Boy she was eating crow!

Carlymel - My Ki67 was 40% and my Oncotype was 24. Like you I had CT x 4. It's reassuring when someone with similar stats did the same chemo. I always wonder how they determine the correct regime and worry perhaps I should have had more chemo. Anyway, I researched the hair issue extensively. While there is a chance that Taxotere can cause permanent alopecia, it is a low risk - around 8%. Yes, cold capping is an expense, it his labor intensive, the caps are cold as heck when you first put them on and yes, they prevent most hair loss with CT x 4. The most hair that is lost using the caps with CT x 4 is 50% according to the research. They were recently FDA approved. My MO said CT x 4 = total baldness. My before and after pics are on my profile for comparison. With that said, the reports of permanent alopecia are rare. Most people see regrowth soon after chemo ends. Chemo & cancer are stressful enough. Don't be frightened by what is statistically rare.

I'm still waiting for my Oncotype results to come in. My MO said I am in the gray zone for needing chemo and we are hoping the Oncotype will be the deciding factor. I had some slight vascular involvement, with grade 3 cells...I just am assuming I'll need the chemo and don't want to be worried for a recurrence if I don't have it.

I have Oncotype 26. My Ki67 was 30%. It is hard to believe the doctors when they pooh-pooh the Ki67 since it has been used in so many studies and is one thing used to distinguish Luminal A from Luminal B. I also have ER+ 80% and PR+ 40%. Mitotic index was 1. My MO steered me away from chemo even with the 26 score, but I have reconsidered and will be having chemo after I'm done with rads. My tumor grade was a 1 (4 on the Nottingham scale) which is why I think my MO said no chemo necessary. But I'm not taking the chance! If I was 90+% positive for ER and PR, I'd probably skip chemo, but then again, I'd probably have received a lower Onco score. I think the PR% is related to how well the hormonal therapy works.

NancyHB, thanks for the reply! My path report said PR+ at 40%, but my Onco report was PR negative like yours. My MO did not really explain the discrepancy and what it means, and I'm still wondering. She just said "oh, it's different, based on genetic expression." Even with my ER+ at 80%, that's not nearly as high as for many women. I have to think that a cancer which is ER+ at 95% or 100% will be somewhat more responsive to hormonal treatment. In any case, I'll be definitely on AI after rads and chemo. My rads will be done first week of April, then it will be chemo.

I see that you just started a 2nd round of chemo for a local recurrence. Any difference in your SE's this time around? I hope they are not too bad.

Oh, I'll have to look on the report when I get home, but I believe my 10 yr risk of distant recurrence with Tamoxifen was 17%, and with chemo it was maybe 10%?? But I'll have to look again. My MO also said AI vs Tamoxifen reduced the 17% to 14%. Then she used a tool on the Onco website where she plugged in my tumor size, age and tumor grade to come up with 7%. But I don't trust that figure. If I had 95% ER+ and PR+ then maybe I would. And why should age be a factor, unless they are assuming a certain number of women die of other things?