Stop Chemo in light of Low Oncotype Dx Score?
Female. 36 years old. Premenopausal. Diagnosed with T2N0 breast cancer.
INVASIVE DUCTAL CARCINOMA WITH MUCINOUS FEATURES, GRADE II-III.
CARCINOMA INVOLVES ALL CORES, LARGEST LINEAR DIMENSION IS 8 MM.
DUCTAL CARCINOMA IN-SITU, HIGH GRADE WITH COMEDONECROSIS, APPROXIMATELY 15%.
Estrogen Receptor (ER): Positive (2-3+, >95%).
Progesterone Receptor (PgR): Positive (1-2+, 70%).
Proliferative Index (Ki-67): 30%.
Tumor size: 2.6 x 1.8 x 2.3 cm. 3 cm from the nipple. The closest skin margin superiorly is 4 mm.
My surgical oncologist said that lumpectomy is not possible due to size of tumor being big and being close to the skin. She and my medical oncologist decided that neoadjuvant chemotherapy would help because of high grade tumor, young age and benefit of reduction of tumor size for a possible lumpectomy.
I was put on 4 cycles of AC and 4 cycles of Taxol with each dose-dense cycle once every 2 weeks.
I have finished 4 cycles of AC already. My Oncotype Dx score result has come back with a low score of 10. Which means that there is not much benefit of chemotherapy if the score is lower than 15 for women younger than 50 years.
Because of the risk of long-lasting peripheral neuropathy side-effects from Taxol infusions, I am weighing the benefits of continuing chemotherapy vs the risk of side-effects of Taxol infusion.
Currently the benefits of continuing chemotherapy are:
1) The tumor will shrink enough to allow a lumpectomy (if it hasn't already).
2) It will kill any microscopic cancer cells (not shown on scans) that have spread to other parts of the body if they haven't been killed in the AC cycles already.
3) You and your doctor will consider the Recurrence Score in combination with other factors, such as the size and grade of the cancer and the number of hormone receptors the cancer cells have (many vs. few). Here, in my case, the size of the tumor is reducing but don't know yet by how much. The grade is high and the number of hormone receptors are also high.
The risks of Taxol infusion are:
Long-lasting peripheral neuropathy which will affect quality of life.
So, I am thinking of requesting my doctor to perform scans to see if the tumor has shrunk enough for a lumpectomy, and if I can forego the Taxol infusions, if the benefit of continuing chemotherapy isn't much.
Friends, anyone who has been or seen this kind of scenario, what would you advise?
Continue Taxol chemo or quit? Please share. Thank you.
Faith Helen Member Posts: 21 Member
I haven't seen or experienced this exact scenario. And, I was 54 when I received my diagnosis. The tumor was significantly smaller than yours, operable, and was removed. My oncotype was 12, I used that to guide the decision to get radiation alone or chemo. I didn't get the message that chemo was of no benefit, but that the risks outweighed the benefit - as you say! I guess what would swing me would be the desire to get that tumor out of my body, asap. Then if they could get it out, we'd regroup from there. I'm Es and Pr + as well and have been on Tamoxifen and then an Arimatase Inhibitor since my surgery in 2016. Best wishes to you on this path.....0
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