Topic: Good oncotype result but hard decision

First of all, I would get a second opinion from a major cancer center. 

My Oncotype score was 16 and I chose not to do chemo, but I got two opinions (one from the Chief of Oncology at a major teaching hosital) and both said no chemo.   My tumor was smaller .3cm, was a lower grade (grade 1) and pure tubular which is supposed to be favorable.   I have yet to figure out why I have a score of 16 since I expected it to be lower.  4 is really low -- that's great -- I would be tempted to forego chemo as well, but I would only feel good doing that if my doctor agreed.  I had two opinions that agreed no chemo.

If your wife really doesn't want to do chemo, I would get another opinion.   But I have heard that younger women often get chemo (I was 47 when diagnosed -- still young, but not 30) --

Good luck -- I know it is an agonizing decision.   I hope that I made the right one myself.

M.

You didn't mention the Her2/neu status? do you know that?

I think first, you need to ASK the first onco WHY he recommends it when the recurrence is so low.

Then yes, a second opinion is in order for peace of mind for you both!

I have an onco-type score of 20. I've had 2 surgeries (lumpectomy) & am now having radiation treatments. One onc feels "ok" with no chemo, but radiation onc says "yes". I've had surgery, chemo, and radiation before for another cancer in which the cancer treatments took the wind out of my sails. (fatigue) I'm on the fence regarding chemo. Any suggestions/comments?

Frankrause, thanks for your comment.

I'm 50, stage 2 with 2 node involvement-Oncotype 20. I'm currently at treatment #18 with radiation and more to follow. Thanks for the Arimedex advice. I'll suggest it to my onc because I am post-menopausal. I was put into premature menopause due to chemo and radiation 9 years ago; but I think this counts as menopause. It sure does feel like it. Thanks again.

hello!
i was just informed my onco test came back inconclusive? no number for me,
anyways i am 34 yrs old and my onc. recommends chemo also.
she said my age was a huge factor, same tx as your wife. thinking of getting a second opinion
my onc. said that being younger doesn't help with the reccurance factor. once you are dx with bc you are at a greater risk of reccurance, soo it might be chemo for myself also?
goodluck!
sue

Hello, I am 43 y.o. was diagnoised at 42 y.o. about 2 months ago. I had stage IIA no nodes, HR positive. and an Onco score of 20 which gives me a 13% chance of reaccurance with hormone therapy and 6.5% chance with chemo, I am on the fence as to what way I should go. my ONcologist says it's my decision.  I am worried about the chemo because I already have some health concerns, sleep apnea, acid reflux, and blood disorder that causes slight anemia. Please can someone help me with my decision. Than you,

Collector, that is interesting your onco thinks it will get lowered.

My onco thinks it will get raised.  

I guess we don't know till we know plus add to that cancer is a crapshoot and no telling what it will do regardless of our treatment (I hate that part).

I was 1 month shy of 50 when Dx (read sig line for dx).

I scored 20 on the onco and I had surgeon, two oncologists, and my radiation onco consult all say that tamoxifen would give me as much benefit as chemo...and chemo carries its own set of problems/side effects.  Chemo would have given me a 2-3% benefit which all docs seemed to think was not worth doing.  My onc said over 4% benefit is a definite "do it."  ILC is also less responsive to chemo (according to some MD Anderson reports), so I opted out.

Of course I second guess myself on and off, but hope if the monster ever comes back, there will be more in the arsenal to fight it.

Best to all you ladies having to make this difficult decision --and to the men who are strong and stand side by side with your women and help out! 

The break-points for low, intermediate, and high Oncotype scores are still the same as they were when the test became available: <18 = low risk; 18-30 = intermediate risk;  >30 = high risk.  What's important to understand is that those categories of low, intermediate, and high, and the cutoffs that form them, are artificial--they're just estimates.  Think about it--what's "low" risk to one person may not be "low" risk to someone else.

The company emphasizes that the relationship between Oncotype score and risk of recurrence is a "continuous variable."  That means a score of 8 has a much lower risk of recurrence than a score of 16, even though they are both in the "low risk" category.  Similarly, the risk of recurrence with a score of 19 ("intermediate risk") is much closer to the risk with a score of 17 ("low risk") than it is to the risk with a score of 29 (also "intermediate risk").  The report includes a graph that calculates the actual percentage recurrence risk for that person's exact recurrence score.  The person's actual recurrence risk (%) is the number that's important, rather than "low", "intermediate", or "high" risk.

The study design for the TAILORx clinical trial does use lower cutoffs when deciding what to do for women enrolled in that study.  Women with scores <11 will get hormonal therapy only; women with scores >25 will get chemotherapy and hormonal therapy; and women with scores of 11-25 will be randomly assigned to get chemotherapy plus hormonal therapy, or hormonal therapy alone.  That change in the cutoffs doesn't mean there has been agreement that the interpretation of the test results should change to those lower numbers.

The cutoffs in the study were lowered to make sure women who had agreed to participate in the trial did not end up being under-treated, or provided therapy that was less effective than the current standard-of-care for ER+ BC.  For example, the designers did not want a woman with a score of 29--"intermediate risk"--being denied chemo because she was on the study, when both she and her onco might have agreed to chemo if she was not on the study.

So, what that means is that a score of 12 or 14 ("low risk" for interpretation but randomized to get chemo/no chemo in the study) is no scarier now, and correlates with no greater risk of recurrence now, than it did when Oncotypte testing first became available.  The whole reason for doing the TAILORx trial is to better define the recurrence risk for mid-range scores (11-25) and the benefits of chemo for those women.  My onco said that's the group for whom there is the most uncertainty about chemo--he told me, "We just don't know."

Here's the Genomic Health website: http://www.genomichealth.com/oncotype/about/hcp.aspx

Here are some links to information about the TAILORx clinical trial:

http://www.cancer.gov/cancertopics/factsheet/TAILORxQandA

http://www.cancer.gov/clinicaltrials/ECOG-PACCT-1

So, the bottom line is that the cutoffs haven't changed yet, but it really doesn't matter because your oncos should be using your actual "recurrence risk" numbers rather than the broad categories anyway.  Once the results from the TAILORx trial are available, things might change; but that will be awhile.

otter