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Sep 26, 2021 02:10AM
Sep 26, 2021 02:15AM
To expand on my previous post: While in the past ILC and mixed type and IDC-L were seen as not different from ILC, more and more, differences are being studied and recognized. I have heard from more than one ILC researcher, and you can read in scientific papers, that ILC, along with mixed type and IDC-L, should be treated as ILC. Here are just some of the differences for ILC, mixed type, and IDC-L:
Imaging modality--ILC types can be harder to image and there may be some trial and error finding what mode works best for a particular patient. (Mammogram, ultrasound, PET-CT, CT with contrast, MRI)
Metastasis sites--While IDC's typical metastatic sites are lungs, liver, bones, and brain, for ILC types we must add reproductive organs, peritoneum, gastrointestinal tract. And there are unusual sites such as the eye etc. So this needs to be kept in mind if a patient is having symptoms, and when reading scans.
Choice of Hormonal (endocrine) therapy--ILC may not respond to tamoxifen, so aromatase inhibitors and Faslodex may be better choices.
Reliance on Oncotype--This patient cohort used for validation this test was mostly postmenopausal IDC. Researchers have been working on a lobular-specific test called LogSig which appears to be more accurate for ILC types. So to my mind, relying completely on Oncotype for treatment decisions with ILC may not be wise.
Timing of recurrence--ILC is more prone to late recurrence, so it is worth considering longer duration of endocrine therapy.
2011 Stage I ITCs sn, premenopausal, Oncotype 16. 2014 Stage IV mets breast,liver. TaxolNEAD. Ibrance+letrozole 2yrs. Fas+afinitor nope. XelodaNEAD 2yrs. Eribulin,Doxil nope. SUMMIT FaslodexHerceptinNeratinib for Her2mut NEAD
2011, ILC, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2-
2014, ILC, 2cm, Stage IV, metastasized to liver/other, Grade 2, ER+/PR+, HER2-
Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)