Bi lateral mx-path=TN Do I still need chemo?

Hey Liz, Sorry you have found yourself here.

You will find a wealth of information, support and encouragement on these boards and I'm sure someone will soon reply who is a lot more knowledgeable than me.

From what I have read chemo is a big weapon when treating triple negative BC. As you are not ER/PR+ Tamox or AI's will not work on your cancer. You are not HER2+ so you won't be treated with targeted therapies like Herceptin.

I have no clue about radiation. It wasn't recommended for me. Did you have any positive nodes? Did your surgeon get good, clear margins? What type of BC do you have?

You may get more responses if you add some details to your profile.

Wishing you the very best. Donna.

If you have an invasive cancer and are negative for estrogen receptors you are not eligible for an Oncotype Dx test, it is only for ER+ as the purpose of the test is for determining whether chemo is beneficial when added to anti-estrogen therapy. Triple Negative is among the most aggressive forms of breast cancer and I believe that most patients with tumors of anything other than a very small size do go on to have chemo, but radiation is dependent on nodal status and location of tumors, and type of surgery. There are several threads here on BCO for ladies with TN, it might be good to see what treatments they have chosen. Here are some links:

https://community.breastcancer.org/forum/72/topics/752075?page=1

https://community.breastcancer.org/forum/72/topics/842786?page=1#post_4698268

https://community.breastcancer.org/forum/72/topics/757916?page=1

You can also check the NCCN guidelines for appropriate treatment for TN with your applicable staging. Have you been given a stage yet? The different ones are contained in the left margin, and you can page through the brochure by clicking on the bottom right of each page until you come to the section for TN.

https://www.nccn.org/patients/guidelines/cancers.aspx

I think that chemo is often recommended for triple negative since it is more aggressive and is not responsive to other drugs. Yet, triple negative is highly responsive to chemo. I had chemo twice, but I am stage IV, so that's not a direct comparison to you. Try to keep an open mind to all the possibilities.

Hi efletcher:

I am a layperson (no medical training). I agree that for purposes of the question of chemotherapy, eligibility requires hormone receptor-positive, HER2-negative disease:

Eligibility: http://breast-cancer.oncotypedx.com/en-US/Professional-Invasive/OncotypeDXBreastCancerAssay/PatientEligibility.aspx

The main output of the test is the multi-gene Recurrence Score, used to address the chemotherapy question. However, the reports also include individual or single-gene Onctoype scores for ER, PR, and HER2:

Single-gene scores: http://breast-cancer.oncotypedx.com/en-US/Professional-Invasive/TheRecurrenceScoreResult/Single-Gene-Scores.aspx

Perhaps this is why the test is being ordered in your case, but please follow-up with your doctor to be certain.

In the typical case, ER and PR status are determined using standard histopathology methods, which are typically more sensitive than the RT-PCR methods used in Oncotype.

Usually, the validated pathology methods ("IHC") used to measure Estrogen Receptor protein and Progesterone Receptor protein look at whole cells. Results are reported as percent positive cells in a field of view (i.e., some cells are stained by a "molecular tag" and are seen as "positive for staining," and some cells are not stained). The percentage of cells that do stain is reported.

Oncotype uses a completely different method ("qRT-PCR") to measure mRNA from ground-up cells. For the single-gene scores, it gives a numerical score in "units", where particular unit values falling below a specified positive/negative cut-off of X units are considered "negative" by Oncotype.

The methods and molecules measured are distinct, and the outputs cannot be directly compared. In the ordinary case of a hormone receptor-positive patient, the individual ER and PR scores can be confusing. See for example, the Discussion in this 2012 paper:

http://www.nature.com/modpathol/journal/v25/n6/ful...

"The additional reporting of qRT-PCR ER and PR results on oncotype report confuses clinicians and unnecessarily creates doubt about validated immunohistochemistry assays."

The individual single-gene oncotype ER and PR scores appear to have limited application, and are not as extensively validated as the central output of the test (i.e., multi-gene Recurrence Score). However, there may be specialized cases where it is appropriate to consider the individual single-gene ER and PR scores.

I am a layperson with no medical training. Therefore, patients should always consult their MO regarding the significance of their pathology results and Oncotype test results to ensure receipt of current, accurate, case-specific, expert professional medical advice. In more specialized cases, a second opinion may be warranted.

BarredOwl

Chemo is horrible but it is doable. What chemo regime is your Oncologist recommending?

What Dr suggested the Oncotype DX test? I would think only an Oncologist should be ordering that.

Grandchildren are such a joy. Congrats. Get treatment underway and enjoy that grand baby. Just my thoughts.

Hugs Donna.