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Topic: use of oncotype dx test on node positive idc

Forum: Stage I Breast Cancer — Meet other members with a Stage I breast cancer diagnosis to share information and support.

Posted on: May 3, 2012 12:47AM

scaredycatwoman wrote:

Hi  Does anyone have any experience with using the Oncotype dx test to decide if chemo is warranted in some one with node positive  1/8,  stage IIa, grade 3 IDC?

One med onc said it should be looked at before deciding if chemo would work and  another one said no --that with my tumor, grade 3 with evidence of lympho-vascular involvement, the oncotype test would not be useful and chemo was the way to go

Has anyone had personal experience this type of situation?

can anyone recommend a med onc in the new york city area or NJ area?

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May 3, 2012 01:22AM coraleliz wrote:

There is a stage III clinical trial(RXponder trial) that is currently recruiting women who are node positive & have oncoscores low to intermediate(I think). There have been smaller studies & there is some data to suggest that oncotype testing can be used on node positive women. I had to ask for the test 3 times before my MO agreed. I was ready to shop around for a MO who would order the test for me. Not sure how stongly you feel about getting the test but you might want to consider participating in the Rxponder trial. I wasn't able to. My onco score was low with 2 poitive nodes & I ultimately decided against chemo. Very hard decision.

Dx 2/28/2011, IDC, Right, 1cm, Stage IA, Grade 1, 0/5 nodes, ER+/PR+, HER2- Dx 3/15/2011, IDC, Left, 1cm, Stage IIA, Grade 1, 2/4 nodes, ER+/PR+, HER2- Surgery 4/15/2011 Lymph node removal: Left, Right, Sentinel; Mastectomy: Left, Right
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Jun 7, 2012 12:31PM Kheng wrote:

For grade 1 tumour hormone receptors positive less than 4 lymph nodes, no chemo required!
Anti-hormone treatment such as tamoxifen for premenopausal and anastrozole for menopausal women!
You may read the book 'Breast Cancer, Taking Control' by Professor John Boyage
In Singapore, many 15 years survivors with your prognosis did not go for chemo, RT and did not take anti-hormone pills as there are deadly side effects too!
Many survivors without tecurrence take Traditonal Chinese Herbs from qualified TCM Oncologist and do not take soya beans, tofu, ginseng, Angelico roots, honey, royal jelly, barbecue foods, deep fried foods, red meat!

Meditate on Psalms 91 and Ezekiel 37 then pray and relax!

Share this good news with your new friends!

3 Cheers from Singapore Kheng

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Jun 7, 2012 01:06PM pupmom wrote:

My MO ordered the test and even with 2 positive (micromets) nodes she said no chemo. Oncotype Score was 14. I am also 63 with a low grade tumor.

Life is what happens while we're making other plans. Dx 10/18/2011, IDC, Right, 1cm, Stage IIA, Grade 1, 2/21 nodes, ER+/PR+, HER2-
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Jun 7, 2012 02:17PM wildrumara wrote:

You didn't mention your age?   Are you premenopausal or post-menopausal??   Not to diminish what yorkiemom and others like her with their diagnoses,  but she is 63.  There is a big difference between a 63 year-old woman with breast cancer and a woman in her 40s.......??  

Aug 2011, dx wth IDC Stage 2, oncotype 25, neoadjuvant chemotTC X 6, BMX with reconstruction, Tamoxifen March 2012, April 2014, two small mets discovered on liver. Arimidex, May 2014 Liver wedge resection. June 2014 SBRT of second liver lesion. Dx 8/23/2011, IDC, 2cm, Stage IIA, Grade 2, 2/20 nodes, ER+/PR+, HER2- Chemotherapy 9/29/2011 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 2/28/2012 Hormonal Therapy 3/26/2012 Hormonal Therapy 5/7/2014 Arimidex (anastrozole) Dx 2/8/2018, IDC, Stage IV, metastasized to other, mets, ER-/PR-, HER2-
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Jun 10, 2012 08:13PM rita65 wrote:

Hi  I received my oxy score and was hi risk for recurrence my score 35.  Taking the chemo will reduce my risk by 12 %.  My score said I had 24% recurrence.  That is to high for me and also a significant inmprovement.  Initially I was told probably no chemo just RAD with a lumpectomy.  My IDC stage 1 grade 2 SNB with no cancer cells in eigther node.  My cancer is ER pos PR Neg and Her Neg.  Generally oxy score are for those with no lymph node involvement and stage 1 or 2.  I would highly suggest that oxyDX be ran if possible.  I start my chemo journey on 6/12/12 this coming Tues.  I do not look forward to chemo but I am so thankful that my onco ordered it because I have made the wise decision to have chem.  I will also have RADS after chemo for about 6 weeks, then on the chemo pill for 5 yrs. The test is geared for your specific cells and onco can treat you with the right therapy for you.  If your insurance pays for it then have it because test the tumor itself after removal. Good Luck to you and all of us.  I intend to fight this fight with all that I have and stay positive!!!  No looking back at my Onco and my decision, just forward to live a long and healthy life. Hang in there, I will!!

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Jun 10, 2012 08:25PM pupmom wrote:

Rita, the Oncotpe Test is NOT just for node negative people. It's for people with node positive also.

Life is what happens while we're making other plans. Dx 10/18/2011, IDC, Right, 1cm, Stage IIA, Grade 1, 2/21 nodes, ER+/PR+, HER2-
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Jun 10, 2012 08:29PM rita65 wrote:

Yorkie Mom posted about age but if oxy score came back at 14 that is pretty low risk for recurrence. 

also I believe the micrometastis is considered node neg.  If my oxy score were 14 I probably would not have chose chemo and I doubt if my Onco would have given chemo. In this case it would have nothing to do with age 63.  

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Jun 10, 2012 08:30PM rita65 wrote:

Yes I stand corrected!!  Thank you!  Hugs

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Jun 10, 2012 08:40PM rita65 wrote:

Geeze  I must be anxious about chemo on Tues., I can't get my brain and fingers to get togther.  I posted that yorki mom posted age but it was Wilrumara.  I stand corrected again...  oh well have the test.  keep us informed.

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Jun 10, 2012 08:44PM pupmom wrote:

Rita, (((HUGS))) sweetie!

Life is what happens while we're making other plans. Dx 10/18/2011, IDC, Right, 1cm, Stage IIA, Grade 1, 2/21 nodes, ER+/PR+, HER2-
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Jun 11, 2012 07:40AM doxie wrote:

scaredycatwoman - First off, are you ER+ and HER2-?  If both, then the oncotype test can help you.

If ER+ and HER2-, I'm guessing that one MO is dismissing the need for the oncotype test because you are grade 3 and have node and lympho-vascular involvement.  If your onco came out low intermediate or mid intermediate, the node and lympho- involement would likely push the scale towards chemo.  Since you are grade 3, it is very unusual for the scores to fall into the low-intermediate or low range.  Very likely the MO sees chemo as necessary and the onco score wouldn't change that.  That MO might also be considering what % your ER and PR are and how effective homone receptive tx will be, as well as other results in the pathology report.  

The other MO might want to see the range in which the onco falls to help guide the type and number of rounds of chemo you might receive, and maybe hope the score will be low enough wouldn't need it.   

Even though grade 2, I could have skipped the onco because my PR was very low and Ki67 very high.  It was pretty clear it would score at least mid- high intermediate.  Did it anyway and is one point below high risk.  Because I know how high my recurrance risk is, it's always in the back of my mind helping push through all other treatment and other activities that will help prevent a recurrence.  It's a useful piece of information to guide you for the rest of your life, not just to decide on chemo.

I'd definitely push for it.  It's another valuable piece of information you can use to make decisions.   

Dx 8/2011, IDC, 1cm, Stage IA, Grade 2, 0/7 nodes, ER+/PR+, HER2- Surgery 9/1/2011 Lumpectomy: Right Hormonal Therapy Aromasin (exemestane) Radiation Therapy Chemotherapy Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Jun 11, 2012 04:54PM WaveWhisperer wrote:

Doxie, I had a grade 3 tumor, but my Oncotype DX score was a very low 8. Because of the grade 3 and micromets, I chose chemo, even though my MO said it was my choice. I declined to participate in the RXponder trial once I decided on chemo. Chemo was hard. If I had to do it over again, I'm not sure what I would do. But at least I know I've done everything I can to prevent a recurrence.  (I was highly ER+, so I'm on Arimidex now....)

Lumpectomy 10/29/2011. TCx4 12/20;1/11;1/31;2/21/12. Started rads 3/19/12. Was in clnical trial testing 3-week course vs. standard 6-week course of rads. Took Arimidex for 2 years, now on Aromasin. Dx 10/14/2011, IDC, 1cm, Stage IB, Grade 3, 1/3 nodes, ER+/PR+, HER2- Hormonal Therapy 7/7/2013 Aromasin (exemestane)
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Jun 11, 2012 04:58PM WaveWhisperer wrote:

P.S. Scaredycat, you'll see from my signature that my DX was quite similar to yours...grade 3 IDC with 1/3 positive nodes. I'm technically a stage 1b, to your 11a, probably because of the size of the tumor.

I'll be happy to help you with any info that can help you. Alas, I'm not in your region of the country and can't recommend docs. 

Lumpectomy 10/29/2011. TCx4 12/20;1/11;1/31;2/21/12. Started rads 3/19/12. Was in clnical trial testing 3-week course vs. standard 6-week course of rads. Took Arimidex for 2 years, now on Aromasin. Dx 10/14/2011, IDC, 1cm, Stage IB, Grade 3, 1/3 nodes, ER+/PR+, HER2- Hormonal Therapy 7/7/2013 Aromasin (exemestane)
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Jun 11, 2012 05:45PM coraleliz wrote:

Wavewhisperer-Just wondering why you are stage 1b & I'm 2a. Were your nodes <2.0mm? or did they change the staging system? It looks like you were diagnosed after me.

Dx 2/28/2011, IDC, Right, 1cm, Stage IA, Grade 1, 0/5 nodes, ER+/PR+, HER2- Dx 3/15/2011, IDC, Left, 1cm, Stage IIA, Grade 1, 2/4 nodes, ER+/PR+, HER2- Surgery 4/15/2011 Lymph node removal: Left, Right, Sentinel; Mastectomy: Left, Right
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Jun 11, 2012 08:08PM Lee7 wrote:

Copied this from this site about the stage.

Stage IB describes invasive breast cancer in which:

  • there is no tumor in the breast; instead, small groups of cancer cells - larger than 0.2 millimeter but not larger than 2 millimeters - are found in the lymph nodes, OR
  • there is a tumor in the breast that is no larger than 2 centimeters, and there are small groups of cancer cells - larger than 0.2 millimeter but not larger than 2 millimeters - in the lymph nodes.

I'm a stage 2A, because my positive node was 3mm.  I guess they have to draw the lines somewhere, right?

I agree with Doxie, getting the Oncotype is another valuable piece of info and it helps confirm what your path report says.

Dx 10/2010, IDC, Stage IIA, ER+/PR+, HER2-
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Jun 12, 2012 07:50AM WaveWhisperer wrote:

Lee, thank you for copying the staging information. I fall into the second definition of 1B, with a 1 cm tumor and cancer cells in the lymph node of about .5 mm. Apparently this is a fairly new and improved way of describing cancer stages. When I filled out a survery form for BC.org, even they did not list 1b as an option.

Lumpectomy 10/29/2011. TCx4 12/20;1/11;1/31;2/21/12. Started rads 3/19/12. Was in clnical trial testing 3-week course vs. standard 6-week course of rads. Took Arimidex for 2 years, now on Aromasin. Dx 10/14/2011, IDC, 1cm, Stage IB, Grade 3, 1/3 nodes, ER+/PR+, HER2- Hormonal Therapy 7/7/2013 Aromasin (exemestane)
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Jun 12, 2012 09:23PM Lee7 wrote:

scaredycatwoman,

I should add that I did ask to have the Oncotype done after they discovered my node was positive.  My score came back a 20,  13% risk and I didn't have chemo, just had rads and then on the AI, Arimidex.  I was glad to have the score to help with the decisions.

And like Coraleliz said, its a very hard decision.

Dx 10/2010, IDC, Stage IIA, ER+/PR+, HER2-
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Jun 13, 2012 07:36AM WaveWhisperer wrote:

Lee, yes, it was a very hard decision for me, too, especially with a low Oncotype score of 8. Now hearing what's happened to Robin Roberts, with a leukemia-like blood disorder as a result of her chemo 5 years ago, I wonder whether chemo was a good idea. Then I tell myself, we just have to make the best decisions for ourselves at the time, given the information we have.

Lumpectomy 10/29/2011. TCx4 12/20;1/11;1/31;2/21/12. Started rads 3/19/12. Was in clnical trial testing 3-week course vs. standard 6-week course of rads. Took Arimidex for 2 years, now on Aromasin. Dx 10/14/2011, IDC, 1cm, Stage IB, Grade 3, 1/3 nodes, ER+/PR+, HER2- Hormonal Therapy 7/7/2013 Aromasin (exemestane)
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Jun 21, 2012 11:48AM - edited Jun 21, 2012 11:55AM by gardengumby

My diagnosis was very close to that of YorkieMom.  I had 2 positive nodes (axillary), had an oncotypeDX score of 14.5, so no chemo.   I'm a person who has always reacted very harshly to any kind of medication/chemical, so I was really worried about chemo, and overjoyed at it not being "required" due to the result of the oncotype test.  On occasion I've been worried (of course) about recurrence but I doubt that I'd be less worried if I did chemo...  (I'm a bit of a worry wart)

BRCA1 & 2 negative - 3 family members. Oncotype 14. DCIS 7.5 cm, intermediate Dx 10/28/2010, DCIS/IDC, Left, 1cm, Stage IIA, Grade 2, 2/19 nodes, ER+/PR+, HER2- Surgery 12/20/2010 Lymph node removal: Left, Underarm/Axillary; Mastectomy: Left; Reconstruction (right): Tissue expander placement
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Jun 21, 2012 07:59PM Lee7 wrote:

gardengumby,

That's how I am, very sensitive to any medications and chemicals. I really couldn't wrap my head around the thought of chemo helping me. I was more afraid I'd be in the small percent that had horrible allergic reactions to it because I had a tough time with just the medicines used during my surgeries.  I've been told not to be such a worry wart, but then I did find my own lump. Thank goodness I worried and went back for them to take a second look.

Dx 10/2010, IDC, Stage IIA, ER+/PR+, HER2-
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Jun 21, 2012 08:20PM Dianarose wrote:

My path report was very ugly. 12 pages of ugly. My MO did the onco dx after my lumpectomy with 4 positive nodes. My score was a 6 despite the 12 pages of cancer in all the tissue they took. 3 weeks later I had a double mastectomy and that report was just as bad. I am doing CMF chemo despite the low onco score because they took 14 more nodes when they did the mastectomy and all were positive for a total of 17 out of 17. My Mo said I could said I could very well be doing chemo for nothing based on the Onco score. I was too afraid not to do something with so many positive nodes. The chemo is not as bad as the fear of it. I am starting to shed some hair which is freaking me out. I do 14 days on and then 14 days off for 6 rounds. I researched cmf verses other chemos and the long term survival difference was only 1-2 percent with a lot less side effects. I don't know if I am doing the right thing and I don't believe any of us know for sure what is right.

I wish all of you the best in making your decisions.

6/10/13 mets to ovary now. Now mets. To peritoneal stage IV Dx 3/22/2012, ILC, Both breasts, 1cm, Stage IV, metastasized to bone/other, Grade 2, 17/17 nodes, ER+/PR+, HER2- Chemotherapy 5/31/2012 CMF Radiation Therapy 12/3/2012 3DCRT: Breast, Lymph nodes Hormonal Therapy 8/10/2013 Aromasin (exemestane) Targeted Therapy
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Jun 21, 2012 08:32PM Lee7 wrote:

Dianarose,

CMF has been around a long time and many oncs continue to use it. Everyone reacts differently to medications and more toxic chemos might only cause more harm than good. 

I considered doing CMF.. There is a thread for it and the ladies there are wonderful. You should check it out if you haven't already.

Dx 10/2010, IDC, Stage IIA, ER+/PR+, HER2-
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Jun 21, 2012 11:32PM - edited Jun 21, 2012 11:34PM by Elizabeth1889

Dianarose, For what it is worth, I think you made the right decision to do chemo. Once I learned that I had one positive node, I felt like I would never feel safe until I did chemo. The experience was not nearly as bad as I feared.

Dx 1/31/2011, IDC, 1cm, Stage IIA, Grade 1, 1/9 nodes, ER+/PR+, HER2-
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Jun 21, 2012 11:50PM coraleliz wrote:

Dianarose-I declined chemo but I would have done chemo if I had your numbers. There's just so much that's unknown. Wishing you well as you continue your chemo. I wasn't offered CMF, just TC. When I asked the MO told me he thought I'd do just fine on TC, something about being healthy...........

Dx 2/28/2011, IDC, Right, 1cm, Stage IA, Grade 1, 0/5 nodes, ER+/PR+, HER2- Dx 3/15/2011, IDC, Left, 1cm, Stage IIA, Grade 1, 2/4 nodes, ER+/PR+, HER2- Surgery 4/15/2011 Lymph node removal: Left, Right, Sentinel; Mastectomy: Left, Right
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Jun 22, 2012 04:31AM Dianarose wrote:

coraleliz- I wasn't offered the cmf either. I did my research and told the MO that't the one I wanted to do. He said he would back up my decision. I wish we all had a crystal ball.

6/10/13 mets to ovary now. Now mets. To peritoneal stage IV Dx 3/22/2012, ILC, Both breasts, 1cm, Stage IV, metastasized to bone/other, Grade 2, 17/17 nodes, ER+/PR+, HER2- Chemotherapy 5/31/2012 CMF Radiation Therapy 12/3/2012 3DCRT: Breast, Lymph nodes Hormonal Therapy 8/10/2013 Aromasin (exemestane) Targeted Therapy
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Jun 22, 2012 09:27PM Lee7 wrote:

Dianarose,

I thought of something someone said a while back on another thread about positive nodes, and it helps me to think of it the same way.  They said they felt the nodes did their job by catching all cancer. 

Dx 10/2010, IDC, Stage IIA, ER+/PR+, HER2-
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Jun 26, 2012 09:56PM curveball wrote:

Is anyone here participating in the clincal trial mentioned above? I had 1st post-surgical appointment with my oncologist today and brought up a clinical trial I am eligible for. The name on the consent form is not RXsponder but it sounds very similar, testing chemo vs no chemo on women with 1-3 positive nodes.

Oncotype score 28--Age 56 at initial DX--mets found at 57 (but I suspect they were there from the start)--mixed IDC & carcenoid (neuroendocrine) tumor. Octreotide (a carcenoid treatment) June-Sept 2013, failed. Dx 3/23/2012, IDC, 1cm, Stage IB, Grade 2, 1/13 nodes, ER+/PR+, HER2- Chemotherapy 7/18/2012 CMF Hormonal Therapy 1/10/2013 Arimidex (anastrozole) Dx 2/26/2013, IDC, 1cm, Stage IV, Grade 2, 1/13 nodes, mets, ER+/PR+, HER2- Hormonal Therapy 6/3/2013 Aromasin (exemestane) Chemotherapy 10/30/2013 Taxol (paclitaxel) Chemotherapy 1/22/2014 Doxil (doxorubicin) Hormonal Therapy 4/7/2014
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Jun 28, 2012 06:44PM Lee7 wrote:

I found out about the Rxponder trial after I'd already started on Arimidex so I wasn't eligible to enroll in it.  I think it is run by SWOG?   I'm interested in the one your Onc talked about.  Keep us posted.

Dx 10/2010, IDC, Stage IIA, ER+/PR+, HER2-
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Jun 29, 2012 01:32AM curveball wrote:

@lee7, after looking around on the OncotypeDX website I found that the trial mentioned by my onc is the RXsponder trial under a different name, and you are correct, it is run by SW Oncology Group (SWOG). I have decided to participate in the trial. I have also started looking for other trials that preceded this one, and found a list of abstracts on the OncotypeDX website. Some of those show no benefit to chemo for patients with low Recurrence Scores, even if they have positive node(s), but it was using a different chemo regime than my onc said he would suggest if I end up in the chemo arm. I want to see if any studies were done using that type of chemo, but haven't searched yet. I will report back when I get the test results, but that will likely not be until week after next, because of the holiday next week. And, I no longer need to search for a tissue bank, because another aspect of the study includes storing samples for use in other research projects. 

Oncotype score 28--Age 56 at initial DX--mets found at 57 (but I suspect they were there from the start)--mixed IDC & carcenoid (neuroendocrine) tumor. Octreotide (a carcenoid treatment) June-Sept 2013, failed. Dx 3/23/2012, IDC, 1cm, Stage IB, Grade 2, 1/13 nodes, ER+/PR+, HER2- Chemotherapy 7/18/2012 CMF Hormonal Therapy 1/10/2013 Arimidex (anastrozole) Dx 2/26/2013, IDC, 1cm, Stage IV, Grade 2, 1/13 nodes, mets, ER+/PR+, HER2- Hormonal Therapy 6/3/2013 Aromasin (exemestane) Chemotherapy 10/30/2013 Taxol (paclitaxel) Chemotherapy 1/22/2014 Doxil (doxorubicin) Hormonal Therapy 4/7/2014
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Jul 12, 2012 06:45PM - edited Jul 12, 2012 06:47PM by cacrew

I'm a newbie....just had lumpectomy with 1/2 nodes positive.  My first MO appointment is tomorrow and I'm asking for the Oncotype DX test.  I'm both ER/PR+ and HEP- but my pathology report does not list % as I'm reading on several of the posts.  Is there other tests to ask for to see if chemo will benefit or not?  Any suggestions appreciated. BTW...surgical pathology report came back showing mixed ductual/lobular cancer...initially it was only ductual. 

Dx 5/9/2012, IDC, 2cm, Stage IIA, Grade 2, 1/2 nodes, ER+/PR+, HER2-

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