Oncotype DX results are in...

Thanks, my mitosis number is 3, ER 100%, PR 20%, Ki-67 20, nuclear score 3, onco = 20. I'm still waiting for my MammoPrint-like scores, they're doing the Prosigna test with me. Still trying to decide about chemo but 99% sure I will skip and go to rads. Thanks for this thread; it's been helpful.

Oops, mitosis score is 1 not 3. Your first chart matches about what my MO said would be my benefit. And of course, I have to do radiation since I only had lumpectomy.

Let me look at my pathology report again and I will post. thanks!

xoxoMichelle

Hi Lisey:

Re your comment above that: "chemo doesn't have an absolute benefit for us gray intermediates":

I think it would be more accurate to say that the study that produced that data did not demonstrate a clear benefit of chemotherapy in the intermediate range as a whole, when comparing two groups of node-negative patients (Paik 2006).

Another way of saying this, is that the test has "prognostic" value (provides information about average risk), but has not been shown to be "predictive" (of benefit of chemotherapy) throughout the standard intermediate range.

In the Paik 2006 study, they were comparing a group that received tamoxifen alone versus a group that received tamoxifen plus chemotherapy. The difference in average 10-yr risk of distant recurrence between these groups falls off with the lines getting closer as Recurrence Scores decline, and getting farther apart as Recurrence Score increases (Figure 4, solid red and blue lines; Second graph in the node-negative report). Here is the original Paik 2006 study and how it characterized the results for the intermediate group:

Paik (2006): http://jco.ascopubs.org/content/24/23/3726.full.pdf

"Patients with intermediate-RS tumors did not appear to have a large benefit [from chemotherapy], but the uncertainty in the estimate can not exclude a clinically important benefit."

"The magnitude of chemotherapy benefit appeared to increase continuously as the RS increased. A clear cutoff point for RS, below which there is no demonstrable benefit from chemotherapy, cannot be accurately defined."

"The benefit from chemotherapy was less clear for patients in the intermediate-risk group (relative risk, 0.61; 95% CI, 0.24 to 1.59; 1.8% increase in absolute risk)."

"Patients with tumors that had intermediate RSs (RS, 18 to 30) did not appear to receive a substantial benefit, but the uncertainty in the estimate (relative risk, 0.61; 95% CI, 0.24 to 1.59) can not exclude a clinically important benefit from chemotherapy treatment."

It is possible that there are differences in this regard within the intermediate range (benefit might differ by score). This is discussed more here:

Genomic Health explanation: http://intermediate.oncotypedx.com/en-US/The-Recurrence-Score-Result/How-An-Intermediate-Recurrence-Score.aspx

The question of whether some with intermediate Recurrence Scores ("RS") may indeed benefit from the addition of chemotherapy is a key point of on-going investigation in the much larger prospective, randomized TAILORx trial. In that trial, those with RS of 11 to 25 were randomized to receive endocrine therapy alone or endocrine therapy plus chemotherapy. In the trial, "those with a score of 26 or higher were [all] assigned to receive chemotherapy plus endocrine therapy." Regarding the study design:

http://www.nejm.org/doi/full/10.1056/NEJMoa1510764#t=article

"Patients with a mid-range score of 11 to 25 were randomly assigned to receive either chemotherapy plus endocrine therapy or endocrine therapy alone because the benefits of chemotherapy were uncertain in this group, yet the risk of recurrence was high enough to suggest that chemotherapy might be beneficial."

They are conducting a multimillion dollar trial, because a clear cutoff point (by Recurrence Score) below which there is no demonstrable benefit from chemotherapy has not been defined.

BarredOwl

[EDITED TO ADD: Please note, the clinical trial described in Paik (2006) and the on-going TAILORx trail are in node-negative (N0) disease.]

Hi Michelle, Your grade 2 consists of 3 parts. Nuclei, Tubules and Mitosis. They add up to either 6 or 7 for a grade 2. do you have those three numbers on the path report?

MFallabella:

I understand that you are still awaiting your Oncotype test results. The most important advice you will receive is the advice from your Medical Oncologist, who is familiar with your results and details of your case.

I'm not sure if people noticed from your profile that you are 44, have ILC, T2 disease (T2 Tumor > 20 mm but ≤ 50 mm in greatest dimension), and are node-positive (pN1).

Please note that a lot of the information in this thread is about the report content and related studies in node-negative disease ("N0"). The report content for node-positive patients and the relevant studies are different.

BarredOwl

Hi. This is what I find so confusing. I'm 50 and with no physical issues. My tumor was removed with double Masectomy and all nodes clean. My Oncotype came back at 21. I have several consults with MO's and asked for feedback from my surgeon and reconstruction plastic surgeon. They all said the same thing. "It's a gray area".

When I asked each of them what they would go if it was them, their wife, sister, etc..... All had the same response. So.... I chose CMF chemo. Took about a week to recover fully.

It's all so confusing in making this decision. I hope I made the right decision as CMF is 8 sessions. Supposed to be less toxic. I'm sure if there was new knowledge, my MO would be sharing it'.

Anyone have any feedback or advice? Good luck to us all.

Heidi

Lisey,

I did. They all said it would still be a gray area, and there is still not enough data to guarantee that some little cell isn't somewhere sitting around. If I was a 19 or 20, chemo would not change the odds enough, but 21 is what made them all concerned. If I was post menopausal it would be a totally different story. They would not have encouraged unless 22 or 23. Unfortunately, I'm 50, but tested with very high estrogen scores.

All of these tests are in their infancy.

I consulted with Georgetown, Johns Hopkins, Mt. Saini, Sloan Ketteting as well as 2 local MO's. Chose local who trained at Sloan Kettering.

Do you have any documentation or info I'm missing?

Heid

Hi, you all are so knowledgeable about the types of tumors and cancer treatments. I feel very ignorant about my choices and decisions so far. I am 66 years of age who at the "young" age of 52 decided to adopt a child from a foreign country. Now fast-forward 13 years and I have a beautiful 15 year-old daughter who needs a mother (me). I keep telling myself that God wouldn't give me this beautiful child and then take me away from her.

In June, 2016, I felt a sizable lump in my left breast. Uh-oh! Went through the mammogram and ultrasound and although they don't come right out and tell you, you know. I then had a lumpectomy of a 3.6 cm tumor, Stage 2, grade 2. Then the oncotype score was 27 so my MO started me on chemo but I hate it. I'm sick most of the time. If I could just lay in bed, drink Sprite and have no one bother me, maybe I could do it. It is very stressful. The only bright spot is that I'm losing weight like crazy because I can't taste. When the side effects started, I swore I wouldn't do the 2nd treatment but now I don't know. I'm scared too like everyone else. Will the cancer come back? What do I do?

candy, you and I share the same treatment and start date. My NP recommends small meals/snacks theoughout the day to vattle nausea. Also, a short walk each day helps. If you are having side effects you should talk to your doctor. There are lots of solutions. Hope you are feeling better today

Srh... So Oncotype that are lower than 10 have a recurrance rate of about 2% within 5 years, as shown by studies. http://www.breastcancer.org/research-news/oncotype-score-0-to-10-can-skip-chemo It could be Srh.. that you are a part of that narrow group and mammaprint found it. I don't know. I'm just saying Oncotype isn't 100% and if there is some type of factor - as yet undiscovered, that leads some low oncotypes to recur, perhaps mammaprint is picking up on it.

Hello all,

I just had surgery a week ago and my pathology report came back yesterday. My BS got clear margins with surgery, no lymph node involvement, no lymphovascular invasion and the tumor size was 1.4cm. I'm 37 (36 when diagnosed) and had IDC. My Oncotype dx score was 25, so in that gray area. I have an appointment with my MO team in a week to go over treatment plans and options and my BS said they will discuss chemo with me at that time. I am not sure if my BS sent a sample of the tumor for Mammaprint, I had to ask for the Oncotype test to be done and I don't want to make her mad if I ask for the mammaprint one, like I'm telling her how to do her job but if this test will show more accurately whether or not chemo would benefit me or not I want to know. My BS said that she has seen people with my onco score need chemo and those who haven't. She said with everything that came back after surgery it's different. Off the top of her head she said she believes the risk without it is 16% which I don't think is all that high and am not sure what the risk will be lowered to with chemo. Should I just wait until meeting with my MO team to ask about the mamma print or should I ask my BS now to send it for testing