Chemo benefit (%) based on your Oncotype DX score

Your info is most helpful, Beesie. It just seems there's too little difference in benefits to choose one AI over another. So should I choose one based on what SE's to avoid instead?

Could there be benefits to using one AI over another in the particular case of DCIS ...or IDC ...or ILC ...or other breast cancers.

Here are my test results:

EndoPredict Breast Cancer Gene Expression Profile
- EPClin Risk Score: 4.5 (high risk)
- 12-Gene Molecular Score: 7.9
- Tumor Stage: pT2
- Nodal Status: pN1mi

RESULTS:
Breast, left, 1 o'clock, ultrasound-guided core needle biopsy
Tumor type: Breast carcinoma
Primary vs. Metastatic: Primary
ESTROGEN RECEPTOR: POSITIVE
- Nuclear Staining: 85%
- Average intensity of staining: strong
PROGESTERONE RECEPTOR: POSITIVE
- Nuclear Staining: 75%
- Average intensity of staining: strong
KI-67: LOW
- Nuclear Staining: 8%
HER2 PROTEIN EXPRESSION: NEGATIVE (Score 1+)
- Staining pattern: Incomplete membrane staining that is
faint/barely perceptible and in greater than 10% of tumor cells

- Lymph Nodes
- Regional Lymph Nodes: Involved by tumor cells
- Number of Lymph Nodes with Macrometastases: 0
- Number of Lymph Nodes with Micrometastases: 1
- Size of Largest Metastatic Deposit (Millimeters): 0.26 mm
- Extranodal Extension: Not identified
- Number of Lymph Nodes Examined: 3
- Number of Sentinel Nodes Examined: 3
- Pathologic Stage Classification (pTNM, AJCC 8th Edition)
- TNM Descriptors: Not applicable
- Primary Tumor (pT): pT2
- Regional Lymph Nodes (pN)
- Modifier: (sn): Only sentinel node(s) evaluated.
- Category (pN): pN1mi
- Distant Metastasis (pM): Not applicable - pM cannot be
- determined from the submitted
- specimen(s)

The micrometastases was found on the outside of the lymph node rather than inside so no intravascular invasion per my MO.

Brilee, even after a MX, a local recurrence remains possible. It's impossible for the surgeon to scrape away every particle of breast tissue, so either a recurrence or even a new primary breast cancer could still develop after a MX. Usually if this happens, the cancer develops against the chest wall, or up against the skin.

Generally for early stage breast cancers the local recurrence risk after a MX is about 1% -2% but the risk could be higher for more aggressive cancers or if the surgical margins are close or if the cancer is node positive and/or very large.

That said, both the Oncotype test and EndoPredict specifically measure distant recurrence risk. I know that the Oncotype test does not provide any information at all about local recurrence risk and I believe this is also the case with EndoPredict.

Here is a copy of an EndoPredict report that I found on their website. I've circled in red where it indicates that the results are specific to distant recurrence.

Mika

for what it is worth- I had an oncotype in the "gray area" which was, as the time between 18-30-- I think mine was in the mid 20's-- did 4 rounds of AC only with a lumpectomy radiation and an AI and ovarian suppression (I could not take tamoxifen). As Beesie says, it is all about your own tolerance. At the time of my dx, A/C was the standard-- I was heartened to see in the Tailor x trial that my numbers would have warranted chemo--- reaffirmed my decision. Also, last on visit they ran the numbers for the recurrence and mine were low--which also gave me reassurrance that I did the right thing-- it is hard to know in the moment--but you have data, doctors and your own gut feeling about what will work for you---- remember, nothing is permanent, you could start then stop-- try one drug, then move to another-- there are many more options available now---- best of luck!

MikaMika, just want to say that I ended up getting 4 opinions until I felt comfortable. A lot of my testing was "discordant" and even contradictory. I would just suggest that you keep going, getting opinions and info from docs, until you feel safe about your decision. My last doc even retested some things.

Oncotype 8, but grade 2 or 3 (depending on hospital), ki67% 18, focal LVI (lyphatic), ER/PR+ and HER2- (had a positive, negative and equivocal and last doc did a retest with more cells)

The Oncotype RSPC model is not new - the first mention of it on this site was in 2011 - but it seems to be very rarely used. I don't know why that is. It takes 2 minutes to run, and doesn't it make sense to try to make the Oncotype results more specific to the individual?

The report that everyone receives with their Oncotype score gives the same % metastatic risk to everyone who has the same score - well, there is the node-negative version and the node-positive version, and there is now a 50 and under score vs. an over age 50 score. But if two people both are node-negative and both have a 29 score, and one is aged 65 with an 8mm grade 1 tumor and will be taking an AI, and the other is aged 51 with a 3.8mm grade 3 tumor and will be taking Tamoxifen, isn't it reasonable to assume that the metastatic risk may be different for these two patients? That's what the RSPC would tell us.

Whatjusthappened, at this point it's too late to change your treatment plan so any new information might just cause you concern. Is that worth it to you?

What just happened also note Tailorx is a node negative study. Node positive is still ongoing. I got both reports because they made a mistake and submitted me as negative. But if it makes you feel better the Rutgers dr said no chemo for dx like ours even with node positive. But I was determined to do chemo and Sloan said yes. I agree that another report might just worry you if there is no chance of changing treatment. Unless chemo is a possibility. It's really not perfect science either way. I looked up trends data and was surprised to see the metastatic rate has not changed at all In 50 years. And people with chemo still go metastatic. So it may just be predetermined. And I'm a little miserable now going through it. I’m an OCDengineer and still have a hard time believing the “limited” data studies. I'm going to get ovaries removed too. How are you feeling after that? Hot flashes?