Oncotype DX: Onc says it's for node+, too (?)

[Barbara2]

After finishing my last "late herceptin" treatment (NED so far), I visited with my onc as to what types of tests or trials might be of benefit to me. I had a list of possible tests, some of which are probably too late; they may only cause me to worry.

I didn't have the oncotype dx listed as an option because I am node positive (1 node). He said it could be used for node positive patients, too, and mentioned that I had only 1 positive node. I have never seen it mentioned on this site, that it can be used for anything other than node neg. breast cancer.

He doubted that my insurance would cover it, but would run it past them to see if it would. It could be a waste of $3.000 if not meant for node positive disease.

Has anyone ever had this test with node positive breast cancer?

Thanks.

[Becky]

I was always under the impression that node positive means chemo no matter what. The Oncotype DX test is for node negative ER+ PR+ cancer whose tumor size is under 2cm (but likely over 1cm) to see if chemo would be of benefit or not.


Seems chemo is always a benefit for node positive regardless of pathology. And node negative if Her2+ or triple negative.

I don't think insurance will pay for node positive as you will need to get chemo anyway.

Just writing what I always thought.

Kind regards

Becky

[Bev]

Read this today, hope it helps.

Use of Genomic Assays

Identification of molecular markers with prognostic significance may help patients avoid treatment that is unlikely to be successful. Clinical studies have demonstrated that adding adjuvant chemotherapy to tamoxifen in the treatment of node-negative, hormone receptor–positive breast cancer improves disease outcome. However, treatment with tamoxifen alone is associated with a 15% likelihood of distant recurrence at 10 years in this population, suggesting that 85% of these patients would do well without the addition of cytotoxic chemotherapy while avoiding the adverse events inherent to such treatment.[1] Nevertheless, the current National Comprehensive Cancer Network[2] and St Gallen[3] clinical practice guidelines, utilizing classic histopathologic and immunohistochemical prognostic markers, categorize less than 10% of these patients at a risk of recurrence low enough to forgo adjuvant chemotherapy.

OncotypeDX is a genetic test developed in collaboration with the National Surgical Adjuvant Breast and Bowel Project (NSABP). The specific goal of this collaboration was to identify a set of reproducible prognostic factors for patients with node-negative, ER-positive breast cancer who had been treated with tamoxifen for 5 years. Notably, this assay was designed to identify continuous risk factors rather than dichotomous ones, with the understanding that the biologic spectrum of breast cancer is a continuous process rather than a fixed, immutable entity. Three independent cohorts were used to examine 250 genes by individual quantitative real-time polymerase chain reaction, and 16 cancer genes were selected based on their robustness as prognosticators.

A mathematical algorithm known as recurrence score was developed based on expression levels of these 16 cancer genes. An independent clinical cohort from the tamoxifen arm of NSABP trial B-14 was used to assess the utility of this algorithm. The investigators found that recurrence score was a valid measure of continuous risk, with an increased score correlating significantly with increased risk of locoregional and distant relapse, as well as death.[4] This relatively novel technology allows clinicians to assess risk and potential benefit from therapy and helps avoids undertreatment or overtreatment.