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Topic: TAILORx: 70% of Women W/ Early-Stage, HR+, HER2- Can Skip Chemo

Forum: Chemotherapy - Before, During, and After —

Regimens, side effects, and support from others going through chemo.

Posted on: Jun 4, 2018 02:22PM

Moderators wrote:

TAILORx Results Suggest About 70% of Women With Early-Stage, Hormone-Receptor-Positive, HER2-Negative Disease Can Skip Chemotherapy
June 4, 2018

Results from the TAILORx study show that about 70% of women diagnosed with hormone-receptor-positive, HER2-negative, node-negative breast cancer do not need chemotherapy after surgery. Read more...

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Posts 31 - 49 (49 total)

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Mar 15, 2020 12:09PM UpstateNYer wrote:

Dottyparker, So sorry to hear of recurrence. I read in another forum where a patient was told by her MO that if specimen is not sent out right away to lab, it can result in an inaccurate score. I always will wonder that about my high Onco score.

Into every life a little rain must fall Dx 2/6/2019, DCIS/IDC, Right, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2- (FISH) Dx 2/8/2019, IDC, Right, <1cm, Stage IA, Grade 3, ER+/PR-, HER2- (FISH) Surgery 3/20/2019 Lumpectomy: Right Surgery 4/2/2019 Lumpectomy: Right Chemotherapy 5/7/2019 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 8/6/2019 Lumpectomy Hormonal Therapy 9/4/2019 Arimidex (anastrozole) Radiation Therapy 9/10/2019
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Mar 15, 2020 10:03PM OnTarget wrote:

A bit late to the party, but I chose to do TC with an oncotype of 16 and ITC's in one node. I was 42 and considered to be in the high clinical risk group by the TAILORx study. It said that I had a distant recurrence risk of ~12% (age combined with clinical risk), and it would go down to 5% with chemo.

I know that the research team thinks that chemo may not be the reason for the better outcomes, but it could be the menopause caused by chemo, but I'm not risking my life on guesses. I decided to do chemo and I'm extremely pleased with my decision.

TC wasn't too bad for me. I feel great now and I know that I did everything I could.

Diagnosed at 42, Oncotype score 16, ITC in one node- considered node negative. Lost right implant to infection March 2020. Waiting to start reconstruction all over again. Dx 4/8/2019, ILC, Left, 3cm, Stage IB, Grade 2, 0/3 nodes, ER+/PR+, HER2- Dx 4/23/2019, ILC, Right, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- Surgery 5/15/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 6/13/2019 Zoladex (goserelin) Chemotherapy 8/5/2019 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 11/6/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Apr 10, 2020 11:37PM - edited Apr 10, 2020 11:38PM by Pprzybylski

After reading The article I'm very interested to learn about an Oncotype 11, and others within the range of below 10 but above 25. I would also be very interested to be a part of the study.

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Apr 11, 2020 07:49PM Moderators wrote:

Pprzybylski, thank you for joining our community, and conversation. You may find our content helpful on Oncotype as well: Oncotype.

What is your situation? Let us know more so we can better help.

The Mods

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Aug 25, 2020 08:08PM - edited Aug 25, 2020 08:10PM by Sunshine99

My Oncotype was around 18, as I recall - this was my first cancer in 2007. I was randomized to have chemo. I was actually glad, because I wanted to throw everything at this disease. I had 4 sessions of CT. I did not have radiation since I had a mast with 0/3 nodes involved.

Fast forward 12 years, and I now have mets to the bone. Interestingly, when I met with the RO to discuss palliative rads to my hip and spine (when I was diagnosed with Stage IV), he mentioned the TAILORx study and said that the study showed that the benefit from chemo the first time was minimal. I find it interesting that I still advanced to Stage IV. I'm still glad I had the chemo. At least I'm not blaming myself for this.

I hope this makes sense. I'm feeling muddle-headed this evening.

The phrase "Cotton Headed Ninny Muggins" came to mind. At least that's how I feel...

Cancer has progressed to my bones. I pray that it never enters my soul. Dx 11/2/2007, IDC, 3cm, Stage IIA, 0/3 nodes, ER+/PR+, HER2- Dx 3/26/2020, ILC/IDC, Stage IV, metastasized to bone, ER+/PR-, HER2- (FISH) Hormonal Therapy 4/22/2020 Arimidex (anastrozole) Radiation Therapy 5/5/2020 External: Bone Radiation Therapy 5/12/2020 External: Bone Targeted Therapy 6/10/2020 Ibrance (palbociclib)
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Aug 26, 2020 08:05AM SummerAngel wrote:

Sunshine99, what grade was your tumor? Just curious.

As you can see from my signature, I was diagnosed at 45, Oncotype of left tumor was 9. I didn't get an Oncotype done on the right tumor (multifocal), which is where they found ITCs. I basically had no treatment other than surgery, as I tried Tamoxifen for a total of about 4 months and couldn't tolerate the side effects. My MO didn't think ovarian suppression would be worth the side effects for me, and I agreed. I'm very happy with my treatment.

Age at dx: 45. Oncotype, left-side tumor: 9. Right side had multifocal IDC and "extensive" LCIS. Isolated tumor cells in 1 right-side node. Dx 3/27/2015, IDC, Left, 2cm, Stage IIA, Grade 1, 0/3 nodes, ER+/PR+, HER2- (FISH) Dx 4/27/2015, IDC, Right, 1cm, Grade 1, 0/2 nodes, ER+/PR+, HER2- (FISH) Surgery 6/1/2015 Lymph node removal: Sentinel; Mastectomy: Left, Right Surgery 6/1/2015 Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 8/28/2015 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant Surgery 12/4/2015 Reconstruction (left): Fat grafting, Nipple reconstruction; Reconstruction (right): Fat grafting, Nipple reconstruction
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Aug 26, 2020 09:07AM Beesie wrote:

Sunshine, here is a chart and graph from the TAILORx study. The chart is a high level result, looking at all ages and grouping the scores into ranges. You can see that overall the difference in benefit by adding chemo, for those with scores of 11-25, is only 0.5%. Regardless of treatment, approx. 5% of patient with scores in this intermediate range will develop a distant recurrence at 9 years. The graph shows the recurrence risk estimates for all scores. The top graph is for those age 50 and under and the bottom graph is for those over age 50. I have marked with an "X" an 18 score. So the RO you spoke to was exactly right - the benefit of chemo is for an 18 score is very small. Unfortunately you are one of the unlucky ones who fell into the small group that did develop a metastatic recurrence, even having had chemo.

.



“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Aug 26, 2020 09:23AM - edited Aug 26, 2020 09:26AM by JRNJ

Note Tailorx is node negative. Node positive trials still underway. Also note NCCN guidelines recommend radiation with Mx with any positive nodes if no alnd, but not all drs are following this. But they radiate nodes even if negative for lumpectomy. This makes no sense to me. Everyone should get radiation. Regarding chemo, there are different types. Sloan is recommending cmf because less permanent side effects. Andromyacin is the one with heart problems. TC is in the middle. The oncotype replaces chemo with endocrine therapy. I'm finding AIs harder them chemo and you have to take them 5 to 10 years. Many women quit. They need to address this. We can't live disfunctuonal. I'm glad I had chemo and radiation in case I quit AIs. But no one tells you this upfront. They assume you must take them.

Pleomorphic Multifocal, Extra nodal Extension, Lymphovascular Invasion. TEs removed due to infection Dx 8/15/2019, LCIS, Right, 6cm+, Grade 3, ER+/PR+, HER2- Dx 8/15/2019, ILC, Right, 2cm, Grade 3, 2/5 nodes, ER+/PR+, HER2- Surgery 9/24/2019 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 12/2/2019 CMF Radiation Therapy 3/30/2020 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 6/4/2020 Aromasin (exemestane) Hormonal Therapy 8/6/2020 Arimidex (anastrozole) Surgery 8/25/2020 Prophylactic ovary removal
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Aug 26, 2020 11:01AM Sunshine99 wrote:

SummerAngel, I actually don't know/remember what my tumor grade was. I might take another look at the surgery and pathology reports.

Beesie, thank you for the charts You continue to be a wealth of information! I was 49 when I was diagnosed. My chemo was TC and I did not get radiation. I did meet with the RO in 2007 before I had surgery. This wonderful man actually remembered me from then even when I saw him 12 years later. He's really good at explaining things.

Cancer has progressed to my bones. I pray that it never enters my soul. Dx 11/2/2007, IDC, 3cm, Stage IIA, 0/3 nodes, ER+/PR+, HER2- Dx 3/26/2020, ILC/IDC, Stage IV, metastasized to bone, ER+/PR-, HER2- (FISH) Hormonal Therapy 4/22/2020 Arimidex (anastrozole) Radiation Therapy 5/5/2020 External: Bone Radiation Therapy 5/12/2020 External: Bone Targeted Therapy 6/10/2020 Ibrance (palbociclib)
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Aug 26, 2020 11:17AM - edited Aug 26, 2020 12:17PM by Sunshine99

I just found my original path report from the mast in 2007:

Tumor grade 4/9
Tubule formation 2/3
Nuclear grade 1/3
Mototic activity 1/3

Does this mean it was Grade 4? Apparently there was also a DCIS component of 1/3; 5% of lesion.

Cancer has progressed to my bones. I pray that it never enters my soul. Dx 11/2/2007, IDC, 3cm, Stage IIA, 0/3 nodes, ER+/PR+, HER2- Dx 3/26/2020, ILC/IDC, Stage IV, metastasized to bone, ER+/PR-, HER2- (FISH) Hormonal Therapy 4/22/2020 Arimidex (anastrozole) Radiation Therapy 5/5/2020 External: Bone Radiation Therapy 5/12/2020 External: Bone Targeted Therapy 6/10/2020 Ibrance (palbociclib)
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Aug 26, 2020 12:14PM Beesie wrote:

Hmmm.... odd. Total grade is a sum total of tubular formation, nuclear grade and mitosis. So it should total to 9, not 7. With the 3 individual scores you mention, your total grade would be 4/7, which is grade 1. Here is a chart that refers to the modified Bloom-Richardson grading system, which I believe is the same as the Nottingham scale.



As for the DCIS, that's a common incidental finding. Most IDC develops from DCIS so it's normal to find some DCIS cells (cells that haven't yet progressed to become IDC) mixed in with IDC. Your DCIS, being 1/3, was also grade 1.

When you were diagnosed in 2020, was any breast cancer found in your breast? It's interesting that your first diagnosis was IDC and your second was ILC/IDC. What was the grade of the 2020 cancer?


“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Aug 26, 2020 12:22PM Sunshine99 wrote:

Beesie, you are correct. The number was 4/9 not 4/7.

The second cancer (mets to my spine, hip and ribs) was found when a lump in my armpit was biopsied, which led to more scans and a biopsy of my spine. There was no cancer in breast, as that was removed in the initial mast. I recalled reading in my recent reports that there were elements of both IDC and ILC. I'm being treated with Ibrance, Arimidex and Zometa. I don't know the grade of this cancer.

Cancer has progressed to my bones. I pray that it never enters my soul. Dx 11/2/2007, IDC, 3cm, Stage IIA, 0/3 nodes, ER+/PR+, HER2- Dx 3/26/2020, ILC/IDC, Stage IV, metastasized to bone, ER+/PR-, HER2- (FISH) Hormonal Therapy 4/22/2020 Arimidex (anastrozole) Radiation Therapy 5/5/2020 External: Bone Radiation Therapy 5/12/2020 External: Bone Targeted Therapy 6/10/2020 Ibrance (palbociclib)
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Aug 26, 2020 12:36PM Beesie wrote:

It seems odd that if your initial diagnosis was IDC that your recurrence would be IDC and ILC. So I wondered if by chance a second primary had developed, one that was more aggressive than your first diagnosis. Even after a MX, a local recurrence or new primary breast cancer can still develop - there are always some breast tissue cells left against the skin, against the chest wall and sometimes on the sides (underarm) or at the top of the breast.

Was the armpit lump an involved lymph node or a cancerous mass separate from a node? And no need to reply if I'm getting into too much detail. I'm just curious as part of my continuing learning about breast cancer. I know that a metastatic recurrence can be a different grade and hormone status than the original cancer, but I never knew that it could be (or include) a different subtype (the addition of the ILC, in your case).

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Aug 26, 2020 12:50PM LillyIsHere wrote:

Sunshine, do you mind if I ask you if you had double or single mastectomy in 2007?

Dx 7/31/2019, ILC, Left, <1cm, Stage IIA, 2/5 nodes, ER+/PR-, HER2- Surgery 9/19/2019 Lymph node removal: Sentinel, Underarm/Axillary; Mastectomy: Left, Right; Prophylactic ovary removal; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 12/1/2019 Femara (letrozole)
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Aug 26, 2020 04:58PM Sunshine99 wrote:

Lilly, I don't mind at all. I had a right total mastectomy with no reconstruction.

Beesie, the report from the US guided biopsy of the lump in my right armpit read: "Metastatic breast carcinoma with ductal and lobular features. Extranodal extension is identified."

The subsequent CT and bone scans and then the bone biopsy identified the mets to my spine, hip and femur.

The only hormone status change was PR which went from positive to negative. The nurse told me the percentages of the ER and PR, but I didn't write them down and don't remember what they were.

Cancer has progressed to my bones. I pray that it never enters my soul. Dx 11/2/2007, IDC, 3cm, Stage IIA, 0/3 nodes, ER+/PR+, HER2- Dx 3/26/2020, ILC/IDC, Stage IV, metastasized to bone, ER+/PR-, HER2- (FISH) Hormonal Therapy 4/22/2020 Arimidex (anastrozole) Radiation Therapy 5/5/2020 External: Bone Radiation Therapy 5/12/2020 External: Bone Targeted Therapy 6/10/2020 Ibrance (palbociclib)
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Aug 26, 2020 10:07PM LillyIsHere wrote:

Thank you for sharing Sunshine. Cancer doesn't follow the rules and that makes it so scary. You can do all the right things, mastectomy, chemo, etc. and it still may be lurking and transforming inside the body and no doctor in the World can figure out.

Are the new meds, Arimidex and Ibrance working on shrinking the cancer? What type was found in the bones, IDC or ILC?

Dx 7/31/2019, ILC, Left, <1cm, Stage IIA, 2/5 nodes, ER+/PR-, HER2- Surgery 9/19/2019 Lymph node removal: Sentinel, Underarm/Axillary; Mastectomy: Left, Right; Prophylactic ovary removal; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 12/1/2019 Femara (letrozole)
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Aug 26, 2020 10:30PM Sunshine99 wrote:

Thank you, Lilly. When I found this lump, I made an appointment with my PCP. The whole COVID thing was just getting underway. She saw me and got me in for an ultrasound the next day. Since it looked suspicious, the radiologist ordered a core needle biopsy. When I had my video visit with my PCP, she told me it was cancer, and asked if I was surprised. I actually wasn't. I just had a feeling about this one.

The other interesting thing is that I've been having severe hip pain since September of last year. I finally got it checked, but the x-ray didn't show any fractures. Now, with this latest find, I had bone scans and a CT scan. The scans showed the mets to my spine, hip and femur (which explained the hip pain). I don't know if the bone mets are IDC or ILC. I only saw that mentioned in the biopsy of my armpit lump.

I'll have my next set of scans at the end of September. My MO said that if they scan too soon after beginning treatment, things may look worse because the cancer may look like it's flaring up when it first responds to the treatment.

What did help with the pain was palliative radiation. I had radiation to my hip, spine and femur. My ortho oncologist does not feel like my hip/femur are in danger of a pathological fracture, but we'll keep an eye on it.

Overall, I feel fine most of the time. Maybe a little more fatigued, and the pain is managed with Tylenol. I feel very blessed. I think this has been harder on my husband, my dad and my sister that it has been on me. I think they imagine me "suffering", which I'm really not. My husband and I love to laugh together and are determined to get through this with grace and humor. We've been married 32 years, and I'm so very thankful for him.

How's that for a long answer to a short question? :)

Cancer has progressed to my bones. I pray that it never enters my soul. Dx 11/2/2007, IDC, 3cm, Stage IIA, 0/3 nodes, ER+/PR+, HER2- Dx 3/26/2020, ILC/IDC, Stage IV, metastasized to bone, ER+/PR-, HER2- (FISH) Hormonal Therapy 4/22/2020 Arimidex (anastrozole) Radiation Therapy 5/5/2020 External: Bone Radiation Therapy 5/12/2020 External: Bone Targeted Therapy 6/10/2020 Ibrance (palbociclib)
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Aug 26, 2020 11:13PM LillyIsHere wrote:

What a story Sunshine. If we can put together a book with stories from this forum, yours should be in there for sure. I am happy to hear you don't have pain and I hope things with improve with the new therapies. Do you do Zometa for the bones?

Dx 7/31/2019, ILC, Left, <1cm, Stage IIA, 2/5 nodes, ER+/PR-, HER2- Surgery 9/19/2019 Lymph node removal: Sentinel, Underarm/Axillary; Mastectomy: Left, Right; Prophylactic ovary removal; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 12/1/2019 Femara (letrozole)
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Aug 27, 2020 10:06PM Sunshine99 wrote:

Lilly, I'm getting Zometa infusions once a month. The first two were kind of rough with nausea and fever, but the next two were not bad at all.

Cancer has progressed to my bones. I pray that it never enters my soul. Dx 11/2/2007, IDC, 3cm, Stage IIA, 0/3 nodes, ER+/PR+, HER2- Dx 3/26/2020, ILC/IDC, Stage IV, metastasized to bone, ER+/PR-, HER2- (FISH) Hormonal Therapy 4/22/2020 Arimidex (anastrozole) Radiation Therapy 5/5/2020 External: Bone Radiation Therapy 5/12/2020 External: Bone Targeted Therapy 6/10/2020 Ibrance (palbociclib)

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