Oncotypex - Score of 22 (Medium Range 18-30) to Chemo or Not?

The oncologist is highly recommending 4 chemo treatments to include Cyclophosphamide and Taxtore. This to be followed with 20 radiation treatments and the ongoing pill for 5 years. Truly on the fence if the chemo is worth doing or not (indicator of 14% recurrence). Other than breast cancer, I think I am healthy...what do I know! Any others had a similar struggle deciding to chemo or not?

JRL - please post more about your diagnosis - it will help people to give an informed opinion.

I had Oncotype of 21 and was not offered chemo.

The oncologist said the risks outweighed the benefits for my diagnosis - I did lumpectomy, rads, Tamoxifen.

I was at 20 Oncotype at 13%, Chemo would only help 3%. My Doc advised me NOT to do chemo. She felt my Mitosis =1 means chemo would not help me as much as hurt me. She practically guaranteed that if I paid for a mammoprint, it would come back low risk. It did. Grade 2 is a hard place to fall, but I had no nodes, Stage 1a, and even a low PR+ and she still said hormonals only. I do plan on switching to an AI/OS in a few years to lower my % by another 3%.

I ended up ordering the mammoprint and turns out.. she was right. I'm low risk Luminal A. (my high Ki# seems to be an pathologist eyeball error). No chemo for me.

Another reason she said no to chemo is the risk of secondary cancers. Which when she showed the risk, added up to more than 3% risk... said she'd rather deal with a BC reoccurance years down the road (Luminals tend to get reoccurances later) than a different cancer due to the chemo.

Sorry, I am new to this site and did not have all the information indicated:

Age 57, Right breast, 1.5m, Stage IA, Grade 2, 0/3 nodes, ER 100%+ with PR 50%+, HER2- Lumpectomy June 2016

Thank you all for the responses! No, I do not recall that the 14% chance was taking into account the radiation or Tamoxifen and will definately ask that question to gain clarity. Oncologist advised that with the chemo I would go closer to the high 90's of not getting a recurrence. Yes, considering a second opinion however, I make the assumption it will be on the opposite side of the fence and back to rolling the dice on either side of that direction.

JRL:

Be sure to get a copy of your Oncotype report so you can study it, confirm the Recurrence Score and the associated recurrence risk. You should also have copies of the pathology reports from all biopsies and all surgeries.

I am confused by your profile information in your most recent post. With a 1.5 cm tumor, if you are purely node negative, with no evidence of lymph node involvement of any kind ("N0"), then you should be Stage IA. What makes you think you are Stage IB?

BarredOwl

JRL, my Oncotype DX score was also 22 a year ago. I have ILC and it was 4cm but MO said chemo wasn't worth it with 22 score. Two nodes had isolated tumour cells. I saw a different MO last week who also agreed that had been the right decision. The title of your thread is not accurate as the medium range of scores is actually 18-30 so 22 is still in the lower range of intermediate with 0-17 being considered low scores. With your high ER an AI will be of most benefit to you.

I agree that getting a second opinion could be helpful. Best wishes going forward.

FYI, NCCN guidelines (Version 2.2016) have a recommended sequence for chemotherapy and endocrine therapy in the adjuvant setting with hormone-receptor positive, HER2-negative disease:

"Chemotherapy and endocrine therapy used as adjuvant therapy should be given sequentially with endocrine therapy following chemotherapy."

If chemotherapy is elected, it should be give before endocrine therapy in the usual case. If there is any question about time to chemotherapy and the sequence of treatments, it is best to seek case-specific advice from an expert medical oncologist.

BarredOwl

Hi JRL:

A single company (Genomic Health) provides the Oncotype test as a "laboratory developed test" used in-house only. If the standard ranges were changed at the end of 2015, then by now Genomic Health would have conducted a massive overhaul of the content on their website to reflect it, which they have not:

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

Different ranges are indeed under evaluation, and the results of the trials may (or may not) lead to some revision in the future.

Late in 2015, some results for those scoring 0 to 10 were published from the TAILORx trial in node-negative ("N0") patients. However, the published results from the 0 to10 cohort in this study, did not operate to change the standard ranges, because they do not speak to outcomes with other scores (11 and above), in which the trial is on-going.

The late 2015 publication provides some explanation for the trial ranges:

http://www.nejm.org/doi/full/10.1056/NEJMoa1510764...

"To minimize the potential for undertreatment of the participants enrolled in our trial, the recurrence-score ranges used in our study differed from those that were originally defined as low (≤10 in our study vs. <18 in the original definition), intermediate (11 to 25 vs. 18 to 30), and high (≥26 vs. ≥31). The recurrence-score strata derived for the trial were based on prior studies that indicated that the risk of recurrence of breast cancer at a distant site at 10 years after diagnosis and a 5-year course of tamoxifen could be as high as 10% among patients with a score of 11 (point estimate, 7%; 95% confidence interval [CI], 5 to 10) and up to 20% among those with a score of 25 (point estimate, 16%; 95% CI, 13 to 20), indicating a risk that was substantial enough for a recommendation of adjuvant chemotherapy in patients with a score of 11 or higher."

In my layperson's understanding, the revised ranges selected for the purposes of the trial are "investigational" until demonstrated otherwise.

Again, no results from the TAILORx trial for the groups scoring either 11 to 25 or 26 and above have been published as of this date, because the trial is still on-going. Therefore, we are still awaiting TAILORx trial results for its "intermediate" and "high" risk groups, and the standard ranges are still in effect (<18; 18 to 30; ≥31).

Nevertheless, patients should not hesitate to discuss the rationale for the TAILORx trial design with their Medical Oncologists to understand whether and how it should be viewed in the context of their individual situation, as it reflects considerations of the magnitude of recurrence risk associated with particular RSs.

BarredOwl

BarredOwl - thank you for the clarity of the details...truly appreciated!

My Oncotype DX score was 20. MO recommended no Chemo for me.

It's like you need a psychic to read your future. I read some people do the aggressive chemo and come out unscathed others permanent damage. Others do the chemo and get recurrences.

Some believe chemo saved their lives. It is a hard decision to make. I chose no chemo and my oncodx was 34.

My doctor thinks I should have done chemo. I knew that my 23% risk of distant recurrence in 10 years was really risky but I chose that route.