MammaPrint and Chemo

I'll just throw this out there. I'd consider having an MO look at your report and discuss with you the risks and benefits. The BS isn't usually the one to manage chemo anyway as surgeons are experts in surgical interventions, MO's are experts in medication interventions. I think just having the discussion about your particular results with the expert in that particular area is useful, if not why bother getting the report.

Hi OG56:

I am very glad to hear you will be meeting with a medical oncologist, which is essential.

The following assumes you received both the MammaPrint and BluePrint tests. Please advise if that is not the case. If not, the following may not apply to your case.

A combined MammaPrint /BluePrint result of Luminal-type (B) reflects a MammaPrint "High Risk" score.

As explained in the sample BluePrint report on-line for Luminal-type subtype (please confirm when you receive your personal reports):

http://www.agendia.com/media/24Feb15_BP-Luminal.pdf

"Luminal-type breast cancers can be sub-stratified into "Luminal A" and "Luminal B" using the MammaPrint categorical result of "Low Risk" and "High Risk", respectively, in combination with the BluePrint Luminal molecular subtype."

In other words, the subtype of "Luminal-type" as determined by BluePrint can be further divided into two sub-categories (either Luminal-type (A) or Luminal-type (B)) based on the MammaPrint risk category:

- If the MammaPrint result is "Low Risk", then the result is Luminal-type (A).

- If the MammaPrint result is "High Risk", then the result is Luminal-type (B).

So if a person is Luminal-type (B) by MammaPrint / BluePrint, then they had a MammaPrint "High Risk" result.

Please be sure to request an explanation of your results, and obtain copies of all documents provided by Agendia (test provider), including:

(a) MammaPrint (FFPE) Result

Depending on the MammaPrint result, either a "High Risk" or a "Low Risk" report will be received.

See for example, this MammaPrint FFPE "High Risk" sample report (USA): http://www.agendia.com/media/25Sep15_MP-High-Risk.pdf

There is a field for "Additional Comments," so it is essential to obtain a copy of your personal report.

(b) BluePrint Result

Depending on the "molecular subtype" result according to BluePrint, you will receive one of the following three reports: a "Luminal-type" report, a "HER2-type" report, or a "Basal-type" report.

See for example, this BluePrint "Luminal-type" sample report (USA): http://www.agendia.com/media/24Feb15_BP-Luminal.pdf

There is a field for "Additional Comments," so it is essential to obtain a copy of your personal report.

(c) Summary of Results

One of the following four reports will be received:

(i) Summary Page Low Risk Luminal-type A; or

(ii) Summary Page High Risk Luminal-type B; or

(iii) Summary Page High Risk HER2-type; or

(iv) Summary Page High Risk Basal-type

See for example, this "Summary Page High Risk Luminal-type B" sample report (USA):

http://www.agendia.com/media/High-Risk-Luminal-62116.pdf

(d) Any additional documentation received (e.g., summary sheets regarding MINDACT trial results)

The "Summary Page High Risk Luminal-type B" report includes some data from an earlier, relatively small study (Knauer (2010)) with the 88% and 76% data points you mentioned (see page 2, top). There are limitations to this particular study, and any medical advice you receive regarding the potential benefit of chemotherapy will not be based solely on these findings, but on more recent studies as well, including the recent MINDACT trial results, in light of your individual circumstances, including considerations such as "Clinical Risk" classification (per MINDACT, as applicable), the settings of lobular breast cancer and recurrent disease, and possible implications of the "Luminal-type B" status determined by this method.

I am a layperson with no medical training. Therefore, all information above should be confirmed with a medical oncologist to ensure receipt of accurate, current, case-specific expert professional medical advice.

Best,

BarredOwl

OG56 - a lot of people see this on their pathology report, and due to the 1b seen after the T, they assume that their stage is 1b - this is a really common error. What you are seeing is actually the TNM staging system description, with 1b indicating submitted tumor size. Here is a link, which has the same info as the link BarredOwl provided above, but in a little bit simpler format.

pT = primary tumor (surgical)

1b = tumor is greater than 5mm (.5cm), but smaller than 10mm (1cm) at greatest dimension.

pN0 = No regional lymph node metastasis identified histologically.

So according to this info, you should be stage 1A. To be 1B you would need to have at least minimal lymph node involvement.

As BarredOwl pointed out, check with your physicians to be sure.

http://pathology.jhu.edu/breast/staging.php

You are right, stage 1B minimal lymph node involvement, the B is not luminal B in this case.

Patients are currently staged using 7th Edition of the AJCC Staging Manual, and the discussion above is based on that version.

Although the 8th Edition of the Manual was published in late 2016, the implementation of the 8th Edition is currently slated for January 1, 2018, per this announcement from the American Joint Committee on Cancer ("AJCC")

https://cancerstaging.org/About/news/Pages/Implementation-of-AJCC-8th-Edition-Cancer-Staging-System.aspx

"Implementation of AJCC 8th Edition Cancer Staging System

The American Joint Committee on Cancer (AJCC) has been working closely with all of its member organizations throughout the development of the recently published 8th Edition Cancer Staging Manual. The coordination of the implementation for a new staging system is critically important to ensure that all partners in patient care and cancer data collection are working in synchrony.

In order to ensure that the cancer care community has the necessary infrastructure in place for documenting 8th Edition stage, the AJCC Executive Committee, in dialogue with the National Cancer Institute (NCI-SEER), Centers for Disease Control and Prevention (CDC), the College of American Pathologists (CAP), the National Comprehensive Cancer Network (NCCN, the National Cancer Data Base (NCDB), and the Commission on Cancer (CoC), made the decision to delay the implementation of the 8th Edition Cancer Staging System to January 1, 2018.

Clinicians will continue to use the latest information for patient care, including scientific content of the 8th Edition Manual. All newly diagnosed cases through December 31st 2017 should be staged with the 7th edition. The time extension will allow all partners to develop and update protocols and guidelines and for software vendors to develop, test, and deploy their products in time for the data collection and implementation of the 8th edition in 2018.

The AJCC is working together with all of its members as well as software vendors to make this transition as smooth as possible for the oncology community. More communication will follow from the AJCC and the member organizations over the coming weeks.

The latest information regarding the AJCC 8th Edition Cancer Staging System can be found at www.cancerstaging.org."

BarredOwl

OG56:

Did you happen to see my long post above re MammaPrint and BluePrint testing? Do you know if you had both MammaPrint and BluePrint tests done?

BarredOwl

The manuals are available to be purchased if one has the money. I found a few medical pptx files on the staging differences online. One stated that the new staging basically requires genetic testing (Oncotype or other) to be included within the staging. It would make sense that by including molecular aggression, some women would drop down a stage even with a larger tumor and others would bump up with a smaller one that has a high risk via the Oncotype.

I go to MSK and am 39 and my MO keeps reminding me of how positive it is that my onco score was low...no one there has mentioned that they don't trust the test. I see Dr. Dang by the way. I guess different doctors there have different opinions

How old are you Amapola? I'm doing the lupron plus AI based on SOFT study results. My MO said tamoxifen alone would be fine for me, but because I did not do chemo, I felt I needed to be super aggressive with hormone treatment.

I have a friend with similar stats to you and we share the same MO. She did recommend chemo for my friend, and she's halfway through. She said it hasn't been as bad as she thought.

This is all just so scary and confusing at times!

Good luck! Are you doing chemo at home then? For what it's worth, I would have done chemo is anyone had recommended it or offered it. It's so scary to be diagnosed at our age.

The SOFT Trial is the one about age. It said that switching to an OS/AI really only helps in a statistical way younger women who have more aggressive cancer and need chemo. Those premenapausal women who have less aggressive cancer and no node involvement are fine on just Tamoxifen. There are a lot of reasons to stay on Tamox versus an AI as well. Tamox doesn't have bone issues and still gives you some estrogen. As long as your uterus stays good and your side effects are mild, my MO recommends staying on Tamox for me rather than switching.

The Study regarding intermediate oncotypes isn't out yet. (TailorX) HOWEVER, the information you've been told isn't accurate. Oncotype is still effective for younger women and MOs do rely on it. My 20 score (I'm age 41) had my MO excited that I didn't need chemo - but it was my choice. I got the mammaprint as a second opinion and it confirmed I was low risk.

I note that the results of the SOFT and SOFT/TEXT trials are typically considered together. Patients can find links to the study publications, as well as the 2016 ASCO Guideline Update issued in light of same, which I posted in another thread:

https://community.breastcancer.org/forum/96/topics/851389?page=3#post_4873888

BarredOwl

OG, I did the same chemo as your are getting. For me, it really wasn't that bad. A lot of little SE's, but nothing major. Your MO will most likely fix you up with several RX's in case they come up. Just be sure you make your MO aware at the onset so you can get them "under control." If you have the Neulasta shot, take 24 hr Claritin a couple days before and after the shot. Drink a LOT of water, rest when you need to and try to walk or exercise when you can. I usually kind of grazed on small snacks throughout the day. I never got nauseated, but did have heartburn after my 3rd TX. You'll be looking at it in your rear view mirror before you know it! Best wishes.