Join Us

We are 225,688 members in 83 forums discussing 164,174 topics.

Help with Abbreviations

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 2, 2012 09:47PM

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?

Log in to post a reply

Page 2 of 2 (53 results)

Posts 31 - 53 (53 total)

Log in to post a reply

Jul 12, 2012 05:30PM Dianarose wrote:

Cacrew- sorry to find yourself here, but welcome. The oncotype will tell how well your cancer will respond to chemo. I got a low score, a 6, but I had 17 out of 17 positive nodes so I am doing the chemo. I too have mixed ductal and lobular. Lobular is very sneaky. It usually doesn't show up on mammograms or other testing like ductal does. I would ask your doctor to order the test to help you make your decisions. It will also give you a recurrance score.

There are a lot of wonderful ladies here to help with all kinds of questions so feel free to ask.

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 5/30/2012 CMF Radiation Therapy 12/2/2012 3DCRT: Breast, Lymph nodes Hormonal Therapy 8/9/2013 Aromasin (exemestane) Targeted Therapy
Log in to post a reply

Jul 12, 2012 07:34PM curveball wrote:

I got the Oncotype results today. My score is 28, so I am out of the trial. The upper limit of eligibility for that is a score of 25. I will be starting chemo next week and really nervous about it but with that score and one node with a micromet I can hardly think of myself as being in a gray area. I have an appointment with my onc next Monday to set everything up, and my first treatment on Wednesday.

@coralize, what was it about CMF that you preferred to TC. My onc suggests TCx4. Before I got the Oncotest results, I was reading the thread about permanent hair loss with taxotere and it made me so anxious I had to stop reading about chemo at all for a few days. But now I am definitely going to be doing it and I don't have much time to learn. If I am going to ask my onc to use a different regimen I need to do it right away.

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
Log in to post a reply

Jul 12, 2012 07:48PM Lee7 wrote:

curveball,

I'm sorry your oncotype came back too high to be in the trial and you have to do the chemo. You might want to read the thread about CMF. The women there are great and can answer questions you have about it.  If you decide to stay with the TC, there are good threads about it also.  I think one of the differences to consider is CMF is usually 6 treatments and the TC will only be 4. 

Dx 10/2010, IDC, Stage IIA, ER+/PR+, HER2-
Log in to post a reply

Jul 12, 2012 09:41PM curveball wrote:

thanks Lee7. I found two threads about CMF, one in the chemo forum and one in help me get through treatment. Looks like a lot of reading to do this weekend....

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
Log in to post a reply

Jul 14, 2012 12:01PM Dianarose wrote:

Curveball- My MO wanted me to do the TC x4 also, but I did my own research and choose the CMF. The long term survival rates were really similar. The side effects from TC verses CMF is what convinced me the most. Also my Oncotype score was a 6 even with 17 positive nodes. My Mo said he would back up my decision. CMF does take longer, but I am still able to work and function most of the time. I have lost about 60-70 % of my hair, but I am not totally bald and a lot of woman don't lose any. It's a tough choice and you can PM me with questions if you want. Do your research in comparing both regimens and make your decision based on what feels right for you. Sorry you have to go through this.

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 5/30/2012 CMF Radiation Therapy 12/2/2012 3DCRT: Breast, Lymph nodes Hormonal Therapy 8/9/2013 Aromasin (exemestane) Targeted Therapy
Log in to post a reply

Jul 14, 2012 01:30PM curveball wrote:

@Dianarose, thanks for replying. After searching the web some more, I found information about taxotere provided by the manufacturer to Health Canada. Twenty-two out of 687 participants in the trial of adjuvant chemotherapy for breast cancer had persistent hair loss. That's about 3%--way too high for my satisfaction. I'm certainly going to ask my MO about my options for other chemo regimens. I won't take a 3% chance of being permanently bald unless that is literally the only option. Hope I don't have to get a 2nd opinion from another onc to be given an alternate plan, because I am 5-1/2 weeks out from surgery and probably should be starting chemo ASAP.

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
Log in to post a reply

Jul 14, 2012 03:24PM Lee7 wrote:

curveball,

I'm just curious about your Oncoscore report that made you a 28. What were your ER/PR scores? It seems if the ER or PR is low than the number goes up. 

My score was 20.  My ER was high which I think helped my number because that means I'd get a lot more benefit from hormone tx.  On my graph it didn't look like I'd get hardly any benefit from chemo.

Dx 10/2010, IDC, Stage IIA, ER+/PR+, HER2-
Log in to post a reply

Jul 14, 2012 04:54PM - edited Jul 14, 2012 04:56PM by curveball

@Lee7, I haven't seen the report yet, I just got a phone call from Dr. F (onc) that my score was 28. I know I am ER+/PR+ but neither my biopsy nor path report has any percentages attached to those scores. Even with completely negative nodes, 28 is right at the top of the "gray area" of intermediate scores and since I have one micromet, chemo sounds like a good idea. I will ask Dr F to review the results with me at my appointment next Tuesday.

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
Log in to post a reply

Jul 15, 2012 10:04AM Dianarose wrote:

http://www.rkefford.com/CMF.html

Curveball- Here is a link about CMF and as I said, the side effects have not been bad and I will be done with my 2nd regimen tomorrow. Don't feel bad about getting another opinion. I got rid of my first MO and even went to Boston for another opinion. All three were all bout TC and but my MO said he would support what ever decision I made and I opted for the CMF and he has been very supportive.

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 5/30/2012 CMF Radiation Therapy 12/2/2012 3DCRT: Breast, Lymph nodes Hormonal Therapy 8/9/2013 Aromasin (exemestane) Targeted Therapy
Log in to post a reply

Jul 17, 2012 03:17PM cacrew wrote:

Thanks for the welcome...went to first oncology appointment and choose the Mammaprint test over the Oncotype DX test...as there is no gray area and it test 70 genes versus Oncotype's 19 genes...for me it was a better choice.  I know that this disease always has the potential for recurrence, but I'm a black and white person...and the Mammaprint has no gray areas that would make me doubt "what if" down the road.

Oncologist also explained that even though 1 node had some cancer tumors present (less that 200) that the node was considered negative...not positive.......which really surprised me.  Explained that pathologist went above and beyond the normal staining of the tissue and the cells could have been a result of dislogement during the biopsy....news to me...good news but not what the Surgeon originally told me.  Has anyone ever heard of that?

Dx 5/9/2012, IDC, 2cm, Stage IIA, Grade 2, 1/2 nodes, ER+/PR+, HER2-
Log in to post a reply

Jul 17, 2012 04:24PM Lee7 wrote:

Yes, I think if the amount in a node is very small, and found by  IHC (I think) staining they consider it negative.  In addition to the one positive sentinel node I had, there was one more which was only showing cells using the IHC stain and my Med Onc dismissed it as negative.

I don't know how I feel about that one....I've read that it matters and that it doesn't.

Dx 10/2010, IDC, Stage IIA, ER+/PR+, HER2-
Log in to post a reply

Jul 17, 2012 08:05PM curveball wrote:

@cacrew, is there a lab in the US doing the Mammaprint test now? I thought there was only one lab, and it's in Europe and can't used a fixed specimen only fresh tissue. But maybe my info is outdated or I've gotten Mammaprint mixed up with something else.

@Lee7, I have also seen conflicting information about the significance of micrometastases and/or isolated tumor cells in the nodes to recurrence risk and expected surviva. Not just node status either...it seems almost any aspect of BC treatment there's a research study that says this or that is a significant indicator of prognosis, and another study that says there's no correlation at all. Adding this drug increases survival...ooops, no it doesn't. Confusing, isn't it?

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
Log in to post a reply

Jul 17, 2012 08:57PM - edited Jul 17, 2012 08:58PM by curveball

OK, well I now have a copy of my Oncotype results in hand. I got both a node-negative and a node-positive printout, but because of that one micromet I haven't even looked at the node-negative versioni.

On the back page, each of the receptor scores is shown in a box, and each also has a graph that looks like a ruler next to it. The ER ruler goes from 3.7 to 12.5, plus room at each end in case your score is less than 3.7 or more than 12.5; my score is 12.0, almost at end of the ruler, which I take to mean that I am very strongly ER positive. On the PR scale, the ruler goes from 3.2 to 10.0, again with room for "more than" and "less than" at each end, and I score 5.7, which is just barely past the cutoff point of 5.5, and I think means that I am weakly PR positive. The HER2 ruler is similar: less than 7.6, ruler from 7.6 to 13.0, with scores below 10.7 negative, between 10.7 and 11.5 considered equivocal, and above 11.5 posivtive. My score of 9.6 is decidedly HER2 negative, but not extremely so.

The front page shows the rate of recurrence* or death** up one side, and the Oncotype score across the bottom. With 1-3 positive nodes, a score of 28 means a recurrence risk of approximately 17% with tamoxifen only, which chemo (specifically CAF-T) would reduce to about 13%. I have to eyeball estimate these percentages from a scale at the other edge of the chart, so take them with a grain of salt, but they are at least roughly consistent with the Adjuvant!online printout I got from Dr F, and with the results I got from the online cancermath.net calculator. This appears to show a benefit for adding chemo of about four percentage points. However, the graph also shows the "confidence interval" on each side of the lines, and this area of doubt is at least twice as large as the estimated benefit of adding cancer. The fine print on the back says my individual hormone and HER2 scores are taken into account in determining this confidence interval. I guess that's why these intermediate scores are considered a gray area. You can't really be sure that including chemo will really improve matters over just tamoxifen. And of course if you use a different chemo regimen than the study, or an AI instead of or after tamoxifen, it really gets to be kind of nebulous. 

Nevertheless, Dr F and I agree that 28 is so close to the edge of the "high" range that chemo is advisable. I wasn't advised to have more nodes removed, despite the one sentinel with 1 mm of cancer, and frankly I think I'd be scared to depend on hormone tx alone to deal with any micromets that might still be in the nodes downstream of that affected one. So tomorrow I'm crossing the Rubicon, and starting 6 months of CMF...unless I chicken out of the weekly schedule for this regimen as done at my treatment locale. I could still go for the TCx4 if I call first thing in the AM. But I don't think I will. That 3% chance of baldness is just too much for me, and Adjuvant!online shows the absolute benefit of the CMF is only 2 percentage points less than that of TC. I've thought about it a lot over the last few days, and the conclusion I came to is if I bet on CMF and lose (i.e. I'm one of the two people in a hundred who die with CMF treatment that would have lived with TC) I'll never know it, but if I take TC and I'm one of the three people in a hundred who end up hairless, I'll never be able to escape that. As far as I've been able to find out, here's no treatment for hair lost this way--not Rogaine, not transplants. When it's gone, it's gone forever. I didn't know if I could deal with having that happen and worse, knowing I had brought it on myself. So I'm not going to take the chance.

*recurrence=after 5 years of follow-up, local recurrence, metastasis or new primary tumor
** death=after 5 years of follow-up, death from either breast cancer or other causes

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
Log in to post a reply

Jul 17, 2012 09:49PM coraleliz wrote:

curveball-good luck tomorrow. I would have done chemo if I had your numbers. I studied the "graph" & studied it some more. I don't have it in front of me but my 2 positive nodes & a score of 4, I think it said I'm more likely to die if I did chemo. When I looked at the confidence interval lines, it wasn't really different than Adjuvant. online.

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
Log in to post a reply

Jul 17, 2012 09:58PM cookiegal wrote:

@scardey cat woman.....

I don't know him personally, but there is a med onc at Montefiore Joseph Sparano, I have read his articles!!! 

www.einstein.yu.edu/faculty/pr... 

He has played a key role in the oncotype research!

If things didn't work out with my onc, that who I was gonna try for.

I was grade 2, but I had one of 8 nodes, an RS of 22 and declined chemo 

You deserve a cookie!
Log in to post a reply

Jul 31, 2012 03:41PM MaryNY wrote:

Hi cookiegal: hope you are doing well.

I too heard of Dr Joseph Sparano when I was faced with making a chemo decision. I had two positive nodes (one originally and later a review of my pathology slides found there were two) so chemo was a given. But when I went for consults with the first two medical oncologists, they recommended different regimens and didn't really take my prior medical history into account. At that stage the Oncotype DX was not mentioned. So I went for a third opinion and that MO did order the Oncotype DX. In the meantime, she was giving me my options regarding chemo. But when the Oncotpye score came back at 18, she said she would leave the decision to me whether to proceed with chemo or not. I felt she was the expert and really should be able to advise me. I struggled with making a decision and felt that I didn't know enough. Someone suggested seeing Dr. Sparano. When I said this to the MO, she called him herself as she knows him well and he said that the existing data on using Oncotype with node-positive women was too scant and he strongly advised that I have chemo. In the end I went to a fourth MO who reviewed everything thoroughly again and strongly advised chemo. I started out with four treatments of AC which I found difficult. Then I had four treatments of CMF. I'm glad I did chemo. 

Mary ~~ lumpectomy 8/10/2009, Oncotype DX 18, Chemo 10/28/09--2/1/10 AC*4, CMF*4 Dx 5/19/2009, IDC, 1cm, Stage IIA, Grade 2, 2/6 nodes, ER+/PR+, HER2-
Log in to post a reply

Dec 28, 2012 04:22PM Nancybc wrote:

Hi Ladies

I am pretty much new to this forum.  I had UMX on November 26th, Still healing,  Mastectomy was with expanders which were filled upto 100cc at the time of surgery but my bad, PS has to deflate them today as my incision kept opening :(.  

Patholgy report shows PR+/ER+  HER-.  NO Lymph node involved.  Waiting for Oncotype Dx test resuls with fingers crossed.  Should hear from the doctor on Wednesday. 

Dx 10/12/2012, DCIS, Stage I, 0/2 nodes, ER+/PR+, HER2- Surgery 11/26/2012 Lymph node removal: Left; Mastectomy: Left; Reconstruction (left): Tissue expander placement
Log in to post a reply

Jan 26, 2013 07:11PM - edited Jan 26, 2013 07:14PM by Mangelucci

This Post was deleted by Mangelucci.
Log in to post a reply

Jan 26, 2013 07:15PM Mangelucci wrote:

<3

Log in to post a reply

Jan 27, 2013 06:52AM Robin3 wrote:

This thread has been so helpful. I guess research is changing all the time. My doctor feels comfortable with a score of 11 and under no chemo. But it helps to see there are options. Thank you all for posting.

Dx 12/18/2012, IDC, Stage IIA, Grade 3, 1/3 nodes, ER+/PR+, HER2- Surgery 1/11/2013 Lumpectomy: Left; Lymph node removal: Left, Sentinel Chemotherapy 2/13/2013 CMF Radiation Therapy 6/10/2013 Breast, Lymph nodes Hormonal Therapy 8/19/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
Log in to post a reply

May 6, 2015 01:49PM worried15 wrote:

Jan 2014 Breast Cancer  2 Positive nodes.  Very small tumor not agreesive hormone receptive.  OC suggested the   oncotype test.  Score was a 9. I was age 59 at that time.  OC said I could do the chemo if I wanted might up the reaccurance score 1.5 or 2 points.  He said he was ok with me doing chemo or not.   I did not choose to do chemo.  I take letrozle.  I had a right mastectomy.  1 year out.  Any one like this?  

 

 

Log in to post a reply

May 6, 2015 06:05PM florida2015 wrote:

is letrozole have side effects that have bothered u

Dx 2/2015, IDC, Left, <1cm, Stage IA, Grade 2, 0/3 nodes, ER+, HER2- Surgery 3/2/2015 Lumpectomy: Left
Log in to post a reply

Jun 1, 2015 06:05AM worried15 wrote:

Yes forida2015.  But with that said not as bad as the arimidex.  I have hot flashes, and some stiff joints with the letrozole, but not as bad as with the arimidex.  I had stage 2B.  I had two positive nodes, low grade, not aggressive.  My onocotype score was a 9.  My OC said he was ok with me not doing chemo.  I choose not to do the chemo.  What about you?      

Page 2 of 2 (53 results)