Luminal A vs. Luminal B stage 1 BC

Sandy, thanks for bringing up the topic of treating with progesterone. Here is a link to a good article which explains the study recently published in Nature regarding the ER and PR receptors. I believe in this study they gave some of the mice actual progesterone. It has some very nice graphics explaining the relationship between the receptors and the hormones.

ChiSandy -

Sigh. I mentioned progesterone to MO yesterday, and she was aghast! "Oh my, that's an old treatment!"

Interestingly, she said to stop the AI - it was of no benefit at the moment. Eighteen months of that s**t! For naught???

I am still bewildered...the awesomeness of an Oncotype of 19 (yay!) and the "Danger, Danger, Will Robinson!" of the Mammaprint/BluePrint. On the same darn specimen.

Really, no benefit for ER positive PR negative

Lisey - I applaud you! I will be anxious to hear if you get a reply as that would be my question after reading your attachment oh HR+.

I remember somewhere during the period of my chemo (2012), I was digging and digging for information on Luminal B. Anything I could find and if I had a memory left, I could go on and on, but at one point I was so fearful of cancer returning I was investigating Metformin. Either the MO or Endocrinologist that my MO referred me to even Rx'd it for me (probably just to give me peace of mind), but ultimately I found one study that had an incidental finding that Metformin not useful in Luminal B. "Incidental" as study was not set up to determine that, so never filled the Rx. It does seem that Luminal B versus Luminal A is a rich area for research. Sadly, as patients, we are on the Applied end of the research train, so anything they are discovering now would still need to be studied studied studied, clinical trials, blah blah. Personally, my hope rests in Immunotherapy. Maybe Luminal would not even be a factor there.

Mammalou - I hope someone answers your question about Tamoxifen versus AIs and PR status, but taking AI, over Tamoxifen confers a 2% reduction in 10 year recurrence from what one's oncoscore gives (Oncotyping totally based on Tamoxifen).

I wanted to ask you why you didn't get Taxol along with AC? We are in the same time frames and that seemed to be a typical regime at the time, AC, then Taxol.

Quinncat - the not getting Taxol has haunted me for years! I had spread to my dermal lymphatic system in my skin which is basically the hallmark of inflammatory breast cancer. My doctors treated me for IBC but my oncologist said there was a study that showed that Taxol was not effective on highly ER cancer. I wish I had gotten a 2nd opinion but at the time I was just overwhelmed. I e mailed with the John Hopkins Ask the expert a year later. She told me I should have had Taxol and at that point I should be happy with every month that goes by without a recurrence. Wow, that didn't make me feel good atall, but I am still doing well

Hi Lisey:

Please be sure to obtain a copy of your Oncotype report for your review and records.

The Genomic Health website has a Sample Node-negative (N0) Report. Scroll down to Page 3 of 3, "Quantitative Single Gene Report" with ER, PR and HER2 sample results on the sample report here:

Sample Report: http://breast-cancer.oncotypedx.com/en-US/Professional-Invasive/Ordering/ReadingTheReports/Node-NegativeReport.aspx

In this node-negative sample report, the "cut-off" values for each individual single-gene score defining "negative" or "positive" are printed in the orange and green bars for each range and noted in the text below, and they are different for ER, PR and HER2. The range considered HER2 "equivocal" is in gray. In your case, the statuses appear to be in accord (ER+ PR+ HER2-):

Your Oncotype Quantitative Single Gene Scores were: ER = 6.6, PR = 6.6, HER2 = 8.8

Your IHC numbers were: 98%ER, 5%PR, and 0 HER2

Based on the information from the sample Oncotype report:

ER score of 6.6 (positive): ER score greater than or equal to 6.5 units is positive

PR score of 6.6 (positive): PR score greater than or equal to 5.5 units is positive

HER2 score of 8.8 (negative): HER2 score of less than 10.7 units is negative (the equivocal range is 10.7 to 11.4 units; and positive is greater than or equal to 11.5 units)

Generally, one should look to the surgical pathology report for an understanding of ER, PR, and HER2 status.

ER and PR as determined by IHC (immunohistochemistry) by the pathologist on surgical samples are typically used to determine ER and PR status for the purpose of endocrine therapy, because IHC is more sensitive than the RT-PCR method of Oncotype. I note that the standard pathology methods and the RT-PCR method of the Oncotype test are quite different, so the results cannot be directly compared***.

Similarly, the single gene HER2 Oncotype score has only limited applicability. The single gene Oncotype DX HER2 score (by RT-PCR) may yield false-negatives for HER2 status, and should not be relied upon as a sole method of determining HER2 status.

I am a layperson, so the above is for information only. Please obtain a copy of your Oncotype report, so you confirm the scores and the "positive" and "negative" statuses set forth in your report.

BarredOwl

***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 ER and PR mRNA from ground-up cells. 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 (if the arrow/triangle falls in the orange range at left).

Jojo, can you give a summary of the article for those of us who don't have access? I am very interested in what it says. Did you decide to have chemo because of your high Ki67%?

hi moon dust ... I chose chemo for my high ki67, and my tumor was misdiagnosed for several years.. For some reason the link will not copy.. It does come up in a Google search

This article is interesting for Luminal B patients. http://www.thebreastonline.com/article/S0960-9776(13)00296-8/abstract?cc=y=