Luminal A vs. Luminal B stage 1 BC

kayb:

Thanks for pointing out that the linked study is in the neoadjuvant setting, and the provider is suggesting that their molecular sub-typing can improve the stratification of patients in the neoadjuvant setting. Typically, one would want to see a separate study in the adjuvant setting (the setting that Lisey is in).

For more information about the test suite from Agendia (MammaPrint, BluePrint, TargetPrint) which I mentioned on page 6 of this thread, see the Physician's Brochure here:

http://www.agendia.com/media/M-ROW-010-V2_Breast-Cancer-Suite-Physicians-Brochure.pdf

Lisey:

I am not sure I understand exactly how BluePrint test results are used or the value in the adjuvant setting. The brochure seems to be saying there are three possible sub-types (Basal-type; Luminal-type; and HER2-type) with BluePrint. In the case of Luminal-type, it appears that the MammaPrint result (High Risk or Low Risk) is used to suggest a clinical course more similar to luminal A or luminal B:

"A Luminal-type BluePrint result means that the tumor phenotype most closely resembles the Luminal-type intrinsic subtype.

Patients classified as MammaPrint Low Risk and Luminal-type can be expected to have a clinical course similar to luminal A, usually treated with hormonal therapy, whereas those with a MammaPrint High Risk and Luminal-type, can be expected to have a clinical course similar to luminal B patients who usually benefit from more aggressive treatment which may include chemotherapy."

Uninformed Layperson Speculation: Unless there is a reasonable possibility that BluePrint would serve up a surprise sub-type (Basal-type or Her2-type) (and I have no clue whether it could or not), then in your case, wouldn't the High risk or Low risk output from the MammaPrint be all you need to answer your question about recurrence risk being more akin to luminal A or B? I don't know. Seems like a question for an expert MO.

I have not investigated the quality of validation of BluePrint (or lack thereof) for any purpose. In my personal opinion, patients considering these tests should consult with an expert Medical Oncologist with experience in using them, who keeps current with the relevant validation studies (and guidelines), and can appropriately advise one whether the tests could provide information of value in your specific case, and are sufficiently validated in the setting applicable to your case to inform your decision-making or not.

BarredOwl

Sorry, Prosigna not Prosthigna.

Lisey, I know that some of the big BC places will do online second opinions for way less than $4200. I think less than $1000. I don't have the names of the ones that do it at hand and no time to google, but please look into it.

Lisey, forgive me if I'm asking questions you've already answered as I haven't read every page of this thread. Factors also assessed when considering chemo are lymphovascular invasion and post surgical margins.

Did you have vascular invasion (direct blood supply to tumour) and/or lymphatic invasion (again direct supply to the tumour)?

Did you have clear margins? (No cancer cells on pathological inspection of the outside margins of the tissue & tumour removed).

Based on your posted stats for tumour size, node status and grade, if your margins were clear and you didn't have lymphovascular invasion; and both ER and PR are considered positive you would meet the criteria for tamoxifen (premeno) or AI (post meno), not chemo. Obviously your PR status is the wild card here and I too would recommend a second opinion.

I was diagnosed Luminal B metastatic a year ago. I had a very rare form so treatment recommendations weren't standard. Ultimately my choice was tamoxifen. Yes, I found all the studies that say it's ineffective for Luminal B but my onc is way ahead of me. Tamoxifen is being successfully used subsequent to surgical intervention, to (best case) prevent recurrence, or at least lengthen the timeperiod between recurrences. There's also a new drug in trials that increases tamoxifen's efficacy in Luminal B treatment (of course I've forgotten the name). I hope this info provides you a little confidence and comfort with the tamox as you ultimately sort out your PR status to define Luminal A or B.

I think I am in a similar position to lisey. Today I have travelled 400km to get 2nd opinion in Melbourne Australia.

The questions I have for This MO are

Survival stats. I have been given 5 years 90%disease free with chemo and 85%without With those stats I was happy to go without chemo. But the more I have read the more it sounds like I have had luminal b. Er 30%,pr neg ki67 20%. It was ILC and grew while I was on tamoxifen.

I am typing this on tiny phone so apologies for typos

What questions would you suggest for my consultation today. I am 65

I am on arimidex and had umx 4 months ago. Have paid for holiday in Italy in October so don't know what I'll do if chemo is her recommendation. Don't know if it is too late.

2nd occurrence.

No oncotype tests here

Thanks

Gerri

Lisey I considered oncotype with my third primary. I can't remember if it was my Onc or the Oncotype folks themselves that told me most of the results were falling into the grey area just below the high range and it ultimately ended up being an individual's personal decision rather than a recommendation. I'd already had tamoxifen so I decided it wasn't worth the money in my case.

With the Luminal B dx the board said they believed I could tolerate more AC but they didn't feel it was the optimum treatment.

Have you tried searching chemo criteria for Luminal B? I haven't bothered for myself, but I did find a few white papers on LB and tamox, only problem is they were outdated. I really think a second opinion is your best option.

Have you started your own personal cancer file? It's very wise to get copies of your reports, scans, bloodwork etc and organize them in a binder. I've even graphed different results and put the graphs in my oncs file for easy viewing of historical data. A single page visual is so much easier than reading through page after page in a file.

Breast Cancer. The unexpected career change that pays volunteer wages.

PS You're not a dud, I'm a BC Petrie dish lol and my typing skills ... gone.

Well had my appt for 2nd opinion and she confirmed all my own thoughts. Now have 30% chance distant recurrence in next 3 years, because of Pleomorphic, ILC, Pr neg and weakly er +. Too late for chemo. Nice to meet someone who acknowledged my concerns. She would have recommended chemo.

Interesting article regarding ki67 and p53 expression for Luminal A.

http://journals.plos.org/plosone/article?id=10.137...

I came across another article which mentioned tumors can be of mixed type and switch between luminal A vs B.