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Do I Need Chemo? Oncotype Testing Explained

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Published on February 5, 2020

Key Takeaways

  • If you're under 50, you have a higher risk of recurrence.
  • Over 50 years old, the cut-off score for chemo can be up to 25.
  • Under 50 years old, the score for needing chemo is closer to 15.
  • Recurrence scores are only one piece of the treatment puzzle.

"Will I need chemotherapy?" is one of the most important questions breast cancer patients ask. Watch as breast cancer expert Dr. Julie Gralow, from the University of Washington, explains the different prognostic tests available, what they really mean and why your recurrence score may indicate something different than you thought.

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Transcript | Do I Need Chemo? Oncotype Testing Explained

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrea Hutton:          

Hello, I’m Andrea Hutton from Patient Power, and I’m very excited to be here at the San Antonio Breast Cancer Symposium, the largest breast cancer conference in the world. Today, I’m very excited to have with me Dr. Julie Gralow, who is the Director of Breast Oncology at the University of Washington in Seattle. As a breast cancer survivor, myself, I have met Dr. Gralow quite a few times, and although she’s not my doctor, I’m very excited to be talking to her today.

So, Dr. Gralow, I’d love to hear your take on a few things that we’ve learned so far, and where the future is for a few things. So, one of the things that I hear about as a patient a lot are these recurrence scores, like you take a test, and it tells you whether or not I’m going to need chemo. Can you talk to me a little bit about what those are, and what we’ve learned about them today?

Dr. Gralow:                

Well, I think the basic premise behind doing these recurrence scores, or more in-depth looking at a tumor, is that we went way overboard in trials that showed that chemotherapy mattered, and we started giving chemotherapy to everybody, because we didn’t know who didn’t benefit. So, these kinds of genomic profiling—the 21 gene recurrence score also called Oncotype or the MammaPrint—they were designed to see if we could pick out a low-risk group that didn’t need chemo, because we were at a point where we were giving almost everybody chemotherapy early stage.

I think what they found, the 21 gene recurrence score reported just in the last couple of years, that we could probably safely omit about 70 percent of the chemo that we were giving in early stage breast cancer, which is huge, and not risk increased recurrence, and certainly reduce toxicity. So, that’s exciting. But it’s not quite that simple, because even within the recurrence scores, it’s not one size fits all.

Andrea Hutton:          

Yeah, you don’t get a yes or a no, plus or minus. It’s a little more complicated. So, what are the things that my oncologist needs to look at besides just that score?

Dr. Gralow:                

Well, I think what we’ve learned out of the 21 gene recurrence score is that age, on top of the recurrence score, matters. That’s probably the most important thing. Also, the tumor size and the grade of the tumor add on top of just the genomics. So, we’ve got added information that needs to be taken into account. So, when you get your report, it’s kind of for all ages, all sizes of tumors. Everybody’s lymph node negative, but when you add in the size and the age, you can get markedly different estimates of what your risk of recurrence, if all you got was endocrine or anti-estrogen therapy, based on those other factors as well. I think that the thing that we’ve looked at in the last year is that 50, as a cut point, above 50, you can go up to a recurrence score of 25 and be pretty comfortable that you’re not getting benefit from chemo. But, if you’re under 50, then maybe the right cut point is closer to 15, instead. So, the younger age has a higher risk of recurrence.

It looks like more benefit from chemo with a lower recurrence score, although whether or not that benefit is, because chemo suppresses your ovaries, and you’re actually getting extra endocrine therapy in a sense. We don’t know the answer to that. But at this meeting at San Antonio, we’re really looking at, should age be added to a MammaPrint and Oncotype, at some of these recurrence estimates, as an independent risk factor, so that we can have better dialogues and better tailor our treatment recommendations. Not just to the tumor, the biology of the tumor, which is what we see in these genomic tests, but also, to the individual patient. 

Andrea Hutton:          

Yeah, so, when patients are talking to each other and they’ll say, “Well, my onco score was X, and my onco score was this, Oncotype score, MammaPrint score was Y.” they might get a different conversation with their oncologist, because they’re different ages, they have different tumor types. So, it’s not a one size fits all, is the way I’m thinking.

Dr. Gralow:                

Exactly, I mean the tumor biology matters. It used to be, we based everything on stage, the size of the tumor and the lymph nodes, and then we kind of went to biology matters. Now, we’re learning, both matter, plus patient factors added on top of that.

Andrea Hutton:          

Just gets more complicated the more we know.

Dr. Gralow:                

Doesn’t that make sense? Cancer’s not just one disease. Breast cancer’s not just one disease. All patients are different, and all tumors are different. So, we’re individualizing, and that’s what’s important and that’s what’s going to get us the best outcomes. Where we’re not overtreating, but we’re also not undertreating. 

Andrea Hutton:          

Well, that’s the most important thing. 

Dr. Gralow:                

Exactly. We’ve got some good, new therapies that will be available soon. I think we’ve got further information to better help us direct the appropriate therapy to the appropriate patient, and that’s really what it’s all about.

Andrea Hutton:          

Absolutely. Well, thank you so much for always bringing us some more knowledge, and hope for our patients and our community. So, thank you, Dr. Gralow. 

Dr. Gralow:                

Thanks, Andrea.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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