New Research on ILC and new multigene prognostic test

Finally. Thank you, Australian researchers! It gives me hope that our children and grandchildren will be better off.

I said it in 2011. I did not believe Oncotype was valid for ILC. I was undertreated.

That is definitely scary to hear of MBC when the situations seemed so benign. I'm glad I'm doing chemo plus OS and AI. Thank you for reinforcing that!

I will read the article!

Lojo- Figure 3- it looks to me like Lob sig had 5 cases of Low Risk people who died of ILC, while Oncotype had 1. It also looks like 4 Intermediate Risk people in the Oncotype column died of ILC and they were all High Risk with Lob sig.

What I do find interesting is the number of people who would be labeled high risk by Oncotype who would change to Low under Lob Sig if they were used independently. One challenge in analyzing this is that the people who had high risk Oncotype scores probably had chemo, so how would you determine whether their longevity was caused by having a low risk cancer versus having chemo?

Meow13- that is really interesting! Yes, definitely wonder what Log Sig would have said for you!

Shetland Pony- your 2011 stats are rather similar to mine including the ITC, except that my tumor was 3cm (plus I had 3 other smaller tumors). I think you would have been in the non-chemo group for the new TAILORx results because you'd be classified "low risk" because of tumor size.

My MO was originally thinking chemo would be overtreatment for me, but I think that the new results put her into the "maybe it will be helpful group". It is so hard to decide since ILC solid tumors don't respond as well to adjuvant chemo. From my point of view it is possible that aggressive ILC ITC's and micromets could respond to chemo.

Hi ShetlandPony, I was primarily looking at Table 2 from the 2019 study results which lists the people under 50 with low clinical risk at a 4.6% chance of distant recurrence without chemo and 4.8% with chemo, for a total chemo benefit of -.2%.

https://www.nejm.org/doi/full/10.1056/NEJMoa190481...

"Clinical risk was defined as low if the tumor was 3 cm in diameter or smaller and had a low histologic grade, 2 cm or smaller and had an intermediate grade, or 1 cm or smaller and had a high grade; the clinical risk was defined as high if the low-risk criteria were not met."

People with high clinical risk who were under 50 on the other hand had an 11.9% chance of distant recurrence without chemo and a 5.5% chance with chemo, for an absolute chemo benefit of 6.5%.

N Engl J Med 2019; 380:2395-2405
DOI: 10.1056/NEJMoa1904819

Also, slightly contradictory to what they said in the quote you have above, they have a table which shows that there was less chemo benefit in women under 40. Women who were 41-45 had chemo benefit, and then women aged 46-50 had more chemo benefit. What I heard them say is that they believe that chemo causing menopause is greater in women aged 46-50, less in 41-45 but still there, and that under 40 chemo won't cause permanent menopause. They associated the ovarian suppression caused by chemo induced menopause with the increased benefit from chemo, not the cytotoxicity of chemo.

One thing I find which disagrees with their theory is the women who were 51-55 before menopause. If their theory of ovarian suppression is correct, the hazard ratio for women who are 51-55 should be even higher than the 46-50 women. But weirdly enough it is below 1. That makes me feel better about choosing chemo- their theory may not be correct, and chemo may be very beneficial. Add that to OS + AI, and I hope all the bases are covered!

Figure 3.

The thought that ITC's in ILC are actually micromets is pretty scary- and it is a great question.

Trying, were your mom’s liver mets de novo (from the beginning of metastatic breast cancer) or did they appear later? I am glad she is doing well! I am doing well, considering, as I have just reached five years with liver mets and pretty good quality of life. Frustrating doesn’t begin to describe the horror that “could have” and “might have” produce. I scream inside my head. Then I decide to keep calm and carry on — what else can I do? That’s why I am so glad ILC is finally getting studied.

Thank you for that detailed reply, OnTarget. I will think more about it and hopefully continue our discussion.