Oncotype scores
Could people who are ER positive, PR-, Her2negative share their oncotype scores. It seems like if you have PR- you will have an oncotype above 25..did anyone have PR- and have a low oncotype score.I was Er+, PR- and had a 29 oncotype.
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Mine was 34.
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I don't believe that being PR- makes anybody hold a higher oncotype dx score, though i don't have a word of support to it, but Oncotype dx score is multi factorial and is not just depended on one.There are certain factors which might be in the genes or the susceptibility of recurrence which can lead to the higher score and the score is not always there to scare you off, talk out with your doctor where he can make a treatment plan for you and please stop worrying about it. a properly curated treatment plan can create wonders for the treatment of cancer. Good luck and god bless.
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The oncodx score predictions are based on magee equations and both the er and pr percentage( the H scores based on pathology) of receptors are used in the calculations as well as other values. The OP is interested in your score if you are pr-.
I don't believe oncodx gives out their proprietary calculations but I have seen the basic set of equations that can estimate a score.
https://path.upmc.edu/onlineTools/MageeEquations.h...
This is an interesting comparison the above link is probably a better predictive for er+ pr+ low grade tumors
https://academic.oup.com/ajcp/article/148/2/167/39...
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Another one on scoring prediction, note the 2nd equation doesn't include ki-67 index.
http://europepmc.org/articles/PMC3647116
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Mine is 50
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PR is just one of the 21 genes measured, but they are not all given equal weight. PR for some reason is given a lot of weight, even more than ER. So a low PR will almost certainly result in a higher score, and this is noted in the articles linked by Meow.
This is the formula:
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My MO told me that PR positivity keeps ER positivity "in check" as it tries to stimulate cancer cell growth. I was 95% ER + and 90% PR positive....but my Ki67 was 90%! My oncotype score: 46....So, PR negativity isn't the only thing that drives up the score! As you can see from what Beesie posted, proliferation is the real deal killer with the score!
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Scrafgal, you're right. PR- is by no means that only factor that drives a high score. Proliferation is a biggie for sure, and a high Ki-67 seems to often result in a high score. That's interesting to me, because Ki-67 measurement is considered unreliable by so many hospitals, including some of the most respected cancer centers, who don't even include it in their pathology reports.
Here is a chart from the appendix of the TAILORx study, which shows the Oncotype score distribution by many of the key patient characteristics and pathology factors. You can see that only 3% of the 951 patients in the study who were PR- ended up with a low Oncotype score. But over half did have an Intermediate score, which is surprising to me, considering what we've seen among the women on this board. (Note that I added in the text in blue.)
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Did anyone have ki67 in their oncodx report? My hospital pathology both from biopsey and mx does not state anything for ki67, I have the full 5 page report from the mx, very detailed.
My oncologist said they don't think it is of value, so he didn't have a value for me. Not sure about oncodx, I dont think I have the full report only a summary.
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Bessie,
It is puzzling as to why so many oncologists dismiss the reliability of ki67 and, yet, still find the oncotype test reliable. The oncotype score was the key driver of my chemo-treatment decision! I can only hope that the other components of the proliferation score are reliable enough to render the overall score substantively valid.
Regarding PR negativity, I recall that my MO suggested that with when PR is negative, estrogen can stimulate cell growth in an "uncontested manner." So, there is something organically defensive about progesterone-sensitivity. The data on the chart was quite interesting. PR-negativity is powerful! This chart also shows the importance of these genomic factors above anatomical factors such as tumor size. There are a lot of small but mighty (in a negative way) tumors out there!
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Meow, my MO said the same thing about Ki-67 and my hospital does not test for it.
Scrafgal, I worry when treatment decisions are based solely on the Oncotype score. To me, too many vastly different diagnoses are grouped together. For example, with 21 genes being assessed, two individuals with very different tumors could end up at the same score - let's say an Oncotype of 32. It might be a completely different combination of points from each of the 21 genes that ended up getting each patient to the 32 score - meaning that genetically these tumors are nothing alike. Then we might have one patient being 67 years old, with a 6mm grade 2 tumor. The other patient might be 51 years old, with a 3.5cm grade 3 tumor. Yet they end up with the same score and therefore receive the same report stating the same metastatic recurrence risk, and chemo is recommended for both patients. Really? And then the question is: Did the clinical trial that validated the Oncotype scores actually have any patients with characteristics and pathologies that matched either of these two patients?
From what I've read, while the Oncotype score is prognostic, so is tumor size, grade, nodal status and patient age. My MO showed me the Oncotype RSPC (Recurrence Score - Pathology Clincial) model - a computer model that Genomic Health make available to oncologists. It takes the Oncotype score and recalculates the recurrence risk by adjusting for tumor size, tumor grade, patient age and the type of endocrine therapy the patient will take (AI vs. Tamoxifen). I think this model makes much more sense than the base Oncotype score, which doesn't consider any of these other factors. I think the Oncotype score has value, but when making treatment decisions, I don't think that all the accumulated knowledge from all the years prior to the availability of the Oncotype test should be thrown out the window.
About the Oncotype RSPC model
https://www.ncbi.nlm.nih.gov/pubmed/29128896
https://ascopubs.org/doi/abs/10.1200/jco.2014.32.15_suppl.570
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Thank you for posting the equation prediction study! My onc didn't even mention oncotype when I was diagnosed, she wanted me to go straight to chemo due to that positive node. I am always wondering what my oncotype would be, those equations do help me find that missing puzzle piece, so thank you for posting it!
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Absolutely agree Beesie. I overstated the role of my score. Look at my profile...my tumor was large...grade 3....I was diagnosed at 50...not young but not old either...all if this went into the decision too...
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However, Beesie, my medical team all agreed that they would NOT trade off my node negative status to get rid of ANY of those other really ugly factors about my tumor. They said that node negativity was a major prognostic factor ( in my favor)...
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Scrafgal, yes, the chemo decision makes perfect sense in your case not only because of your Oncotype score but also because of your pathology. I have to admit though that in reading the board, there are lots of cases that have me scratching my head, when I see chemo decisions - either to have chemo or not have chemo - being made solely based on the Oncotype score and seemingly with no consideration to the pathology. It's especially concerning when the Oncotype score just scrapes by on one side of the line, either leading to a chemo recommendation or a no chemo recommendation based on a borderline score - with the recommendation seeming to be contrary to what the pathology would suggest.
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I agree, Beesie, the simplicity of the oncotype as a decision factor could steer some of us to make a less than optimal decision, either way.
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My score was 36. Starting chemo in 2 weeks.
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Another good point you made, Beesie, is about making decisions based on arbitrary cutoffs. Being diagnosed at 50 is frustrating because treatments and prognosis seem to revolve around under 50 or 50+. I was a youngish 50..at the time, no where near menopause, physically fitter than most at 50 etc. with no comorbidities. My doctors considered my treatments with this in mind...as though I was actually 49:) that makes sense to me.
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Hi everyone. I don't have an oncotype score. When I sent a message to my medical oncologist asking about the test, I received a reply from the nurse that I was not a candidate to have my oncotype determined "because you don't want chemotherapy." No one ever talked to me about an oncotype score. I was led to believe that if I underwent radiation therapy and took tamoxifen, I would not need chemotherapy. So it is in my records that I don't want chemotherapy - which is true, no one wants it, but I didn't refuse it, either. I am so very confused. Should I be insisting on an oncotype test? Right now, I'm considering not having radiation because of my age (67). I'm also considering not taking tamoxifen, because I had a difficult time trying to wean off my HRT (won't go into those details). I was told I had a 30% chance of recurrence if I don't go through radiation and tamoxifen. Would an oncotype determination help me make a more informed decision as to what therapies I should proceed with? I really appreciate it, everyone.
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My MO doesn't use Oncotype, he told me it's to make the chemo decision and given the type, grade, etc of BC I have, we already knew chemo wasn't the right option.
But I did want to know what my risk of recurrence was so I could make an informed decision about hormone blocking drugs. So he ordered a MammaPrint test and said if I came back ultra low risk, he was fine with me not taking tamoxifen. Unfortunately I came back low risk but awfully close to high risk so there's that.
Just figured that my experience might be useful to you--maybe your MO uses the MammaPrint. Big warning though, it's pricey and looks like at least for me not in network. Which has me gulping over that nearly $9k bill.
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I think some oncologist's are uninformed just because you have a low grade and are hormone positive with no node involvement doesn't mean you will get a low score or won't benefit from chemo. The tumor however does need to be over 5mm I believe.
It is information I would want to know. There is also oncodx scoring for DCIS/LCIS. If you have an uncommon cancer it may not be as useful. It is a statistical tool. Most insurance will cover the 4,000 dollar cost.
This particular thread is interested in your score if you are er+ pr-.
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I had been told that if your tumor was clinically low risk as assessed by Adjuvent Online but also in the Mindact study where the results of the use of mammoprint were published, that if you had a low clinical risk and from your description you would be that even if you had a high mammoprint score that you would not benefit from chemotherapy. Some oncologists seem to not know this and ASCO said that mammoprints should only be given to people who were at high clinical risk. At least that is what I have read..but you should check it out. Either way from mammoprint chemo would not be recommended.
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Interesting I was low risk on Adjuvent online. I was always bothered by the number representing both risk of recurrence and benefit of chemo doesn't seem like that would necessarily be true. I would think them not related.
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- donnalee, I am a bit surprised that at age 67 you will be on tamoxifan. I understood this to only be for those who had not yet gone through menopause. Arimidex or another aromatase inhibitor is usually given to those of us who have gone through menopause if we are ER+ and/or PR+. Also, my tumor was grade 1 as was yours and my doctors wanted me to have the Oncotype done. I would have insisted on it if they had not suggested it first. Chance is pretty good that you won't need chemo but it's nice to have additional information and confirmation of that. Best wishes!
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I was ER+/PR-, but my tumor was classified as low risk so no oncotype was performed. My treatment was done at Ohio State, the same institution which compared the equations to the oncotype score.
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letsgogolf, tamoxifen is what my MO recommended for me even though I've gone through menopause. I have osteoporosis so the AIs are off the table because of their impact on bones.
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It is all so confusing because different doctors give such different opinions on just about everything. My sister has osteoporosis and I have osteopenia. We were both told (by different doctors at different facilities) that we could not take Tamoxifan because we had gone through menopause. We are both on Arimidex and are given meds for our bones. She initially took monthly Boniva for 5 years and now is given Prolia shots twice a year. I am on Fosamax, once per week.
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My case may be slightly different since I did fracture my pelvis last year running. So no fall, no blunt force trauma--just from running. Since AIs do weaken bones, and apparently tamoxifen can strengthen bones, that's the recommendation. My cancer is also strongly ER positive. Who knows.
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I found this article interesting.
https://www.cancernetwork.com/articles/anastrozole...
When my oncodx scoring was done only tamoxifen was mentioned not AI drugs. I did AI drugs my oncologist thought it more effective for er+ pr-. I think my bones took a hit though.
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Meow13 - Very interesting article. Thanks for posting the link!
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