Topic: Information on decisions with Oncotype score

Forum: IDC (Invasive Ductal Carcinoma) — Just diagnosed, in treatment, or finished treatment for IDC.

Posted on: Feb 16, 2019 10:24AM - edited Feb 16, 2019 10:14PM by ZEKE

Posted on: Feb 16, 2019 10:24AM - edited Feb 16, 2019 10:14PM by ZEKE

ZEKE wrote:

I am interested in your decision and outcome based on a HIGH Oncotype score.

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Jun 22, 2020 04:19PM cowgirl13 wrote:

Noone, definitely, definitely get the RSPC test and if your oncologist doesn't seem interested in ordering this test, demand it. It's a very good test. Good luck with this.

Be the kind of woman that when your feet hit the floor each morning the Devil says: 'Oh crap! She's up! Dx 5/28/2009, IDC, Left, 2cm, Stage IIA, Grade 3, ER+/PR+, HER2+ Surgery 6/17/2009 Chemotherapy 8/3/2009 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 12/21/2009 Hormonal Therapy 2/23/2010 Arimidex (anastrozole)
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Jun 22, 2020 04:59PM salamandra wrote:

Definitely not disagreeing with the great advice to follow up for more info. But also - a case like yours (if it's correct) is exactly the kind of thing that oncotype is meant to catch! If it always aligned with clinical risk factors, there would be no benefit to this fancy genetic test.

Dx at 39. 1.8cm. Oncotype 9. Dx 9/19/2018, IDC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- Surgery 10/18/2018 Lumpectomy; Lymph node removal Hormonal Therapy 11/1/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy 12/3/2018 Whole breast: Breast Hormonal Therapy 12/19/2019 Fareston (toremifene)
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Jun 22, 2020 06:37PM - edited Jun 22, 2020 08:47PM by

Salamandra, the Oncotype RSPC model uses as it's base the Oncotype score, and then refines the recurrence risk based on clinical and pathological factors. So the model isn't ignoring the Oncotype results but is building upon them. The Oncotype RSPC model personalizes the recurrence risk that is associated with the Oncotype score. But it fully accepts the score.

The Oncotype score is derived from a detailed genetic assessment of the tumor - in other words, everyone's score is based on the genetics of their tumor. The 9-year metastatic recurrence risk that is associated with each score comes from research studies that tied long-term outcomes to patient's scores. So everyone (within each of the two age groupings) with the same Oncotype score receives the same recurrence risk; this recurrence risk is an average, compiling the results of everyone in the study and mapping the results to the Oncotype scores. If a someone presents very differently than the average of everyone in the study then it makes sense that the recurrence risk associated with the average might not apply to that individual. This is precisely why the Oncotype test is not recommended for people who have tumors that are smaller than 5mm - because the study included no patients with such small tumors.

Noone's tumor was 0.8cm. Within the TAILORx study, the average tumor size was 1.75cm; for those with scores of 26 or higher, the average size was 1.88cm. Noone's tumor was grade 1. Within the TAILORx study, only 26% of the tumors were grade 1; for those with scores of 26 or higher, only 6.5% had grade 1 tumors. Noone's age is 60. Then average age of participants in the TAILORx study, in the 'age 50 & over' subgroup, was under 60. Even with identical Oncotype 29 scores, would we expect two patients, one age 52 with a 2cm grade 3 tumor, and the other age 60 with a 0.8cm grade 1 tumor, to face the exact same recurrence risk? Obviously the Oncotype people don't think so, since they make the RSPC model available to oncologists.

Discordance Between Oncotype DX Recurrence Score and RSPC for Predicting Residual Risk of Recurrence in ER-positive Breast Cancer

"In node-negative patients, RS can be integrated with clinicopathological parameters to derive RS-pathology-clinical (RSPC) that improves prognostic accuracy." *Note: RS stands for Recurrence Score, i.e. the Oncotype score.


Risk of Recurrence and Chemotherapy Benefit for Patients With Node-Negative, Estrogen Receptor–Positive Breast Cancer: Recurrence Score Alone and Integrated With Pathologic and Clinical Factors

"In summary, RSPC risk assessment integrating RS with traditional pathology and clinical measures adds significant prognostic information to RS. RSPC can aid in making chemotherapy decisions by refining assessments of recurrence risk where RS and traditional measures are discordant, especially with intermediate RS, by reducing the number of patients classified as intermediate risk and enhancing confidence in the integration of RS with traditional measures."

Edited to add: The Oncotype RSPC model doesn't need to be ordered. Every MO should have access to it on their computer, directly from Genomic Health. It takes no more than 2 minutes to input the variables (Oncotype score, patient age, tumor size, tumor grade, whether the patient will be taking an AI or Tamoxifen) and the new recurrence risk is immediately calculated.

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Jun 22, 2020 07:42PM hopeful82014 wrote:

Beesie (and anyone else who's interested) per your comment copied below -

Neoadjuvant endocrine therapy does not impact the Oncotype score directly, as the protocol is to use tissue from the original, pre-treatment biopsy in that situation. It is possible that over the months of treatment prior to surgery the tumor biology could change if the tumor is adapting to treatment, which I suppose could theoretically impact the practical accuracy of the Oncotype's predictions. With a grade one tumor I think that is probably fairly unlikely.

This information is based on information provided to me by 3 different oncologists several years ago.

I hope this helps!

"I don't know if having started on endocrine therapy prior to surgery would impact your tumor biology and therefore impact your Oncotype score. I imagine it would, but that's just a guess. And from what others here have said, it is possible that the time between surgery and sending in the sample for Oncotype testing could also have an impact, but again I don't know. While there is evidence that this may be an issue, I don't think it's been proven (yet)."

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Jun 22, 2020 08:42PM wrote:

Hopeful, thank you. That's really helpful information.

In Noone's case, the question is whether the tissue sent for Oncotype testing was from her biopsy - my interpretation from her post was that it was a surgery sample, but this should probably be asked and confirmed.

And for anyone else who finds themselves in a situation where endocrine therapy was started prior to surgery, it will be important to specify that biopsy samples be used for Oncotype testing. There are a lot more people who are in this situation today than would usually be the case because many surgeries were delayed due to Covid-19 and patients were put on endocrine therapy to hold them over until surgery.

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Jun 30, 2020 02:10PM ZEKE wrote:

Hi Zeke here. Well I took all 3 hormone therapies EXCEPT Tamoxifen. I could not take them the joint pain was severe and I mean severe I could not walk I was hobbling like a cripple. It was incredibly painful. I did give them my best shot one for 6 months one for 2 months and one for 3 months all with the severe side effect. Its just my body I guess. Now the next and last one I will be trying is Tamoxifen. I am waiting for the Femera to get out of my system for a month and am waiting to walk normally I am sill in severe hip joint pain from it.

My oncologist told me Tamoxifen will not give me that severe joint pain, but I read it causes bone pain what's the difference?

Anyway I will give this a shot also. And wanted to tell you I did try ibuprophen, Tylenol etc. to relieve the joint pain but it did not phase it.

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Feb 5, 2021 10:51AM ZEKE wrote:

Hi I said a month in my post so I am good to go but have been on Tamoxifen now for 6 months with creeping side effects after all that time!

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Sep 26, 2021 05:06AM oldladyblue wrote:

I found this thread applicable to me, since I am Oncotype 28 and undecided on chemo. There isn't one place on this site to look for Oncotype score information, the searching takes up a lot of time.

Surgery 7/1/2021 Lumpectomy (Left); Lymph node removal (Left): Sentinel Chemotherapy 10/8/2021 Other Radiation Therapy 1/4/2022 Whole breast: Left breast, Lymph nodes Hormonal Therapy 3/10/2022 Arimidex (anastrozole) Dx IDC, Left, 1cm, Stage IA, Grade 2, ER+/PR+, HER2-

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