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Lisa Schneider-Cipriano: What is the difference between the KI67 and Oncotype DX? Are they
closely related and is one more accurate than the other?
Jay K. Harness, MD: Terrific question. They are two completely different things.
KI67 is what called a proliferation index. Oh my goodness gracious, what is that fancy
stuff mean. In other words, how faster the cells growing and one of the reasons that
medical oncologists look at the KI67 is to give them an idea Lisa about how somebody
may respond to chemotherapy, because the faster the cells are growing, then typically the
more responsive they are going to be to chemotherapy and so often the KI67 is related to the differentiation
of the cancer. So, we have talked about this before that we have well differentiated
invasive cancers. We have intermediate or moderately differentiated and we have high
grade or poorly differentiated, three categories. Typically, with a really high grade, poorly
differentiated cancers, those are bad actors. The cells are turning over rapidly and the
KI67 typically shows that and it's a percentage number. So, it's one use by the medical
oncologists, they have talked about the issue of chemotherapy or not. Now, how does that
relate to Oncotype DX and this question actually comes up in my weekly conference, so here
at St. Joseph Hospital, we do a weekly multidisciplinary breast cancer conference, and this question
about KI67 and the Oncotype comes up. Remember that the Oncotype DX is a gene analysis of
the tumor itself. It does a couple of things not only saying one of the chances of the
cancer coming back in the next 10 years elsewhere in your body, but also whether you are potentially
going to benefit from chemotherapy or not and so with high risk scores and high recurrence
scores, with the Oncotype DX, we know those patients need chemotherapy. With the low
recurrence scores, we know that patients are going to benefit from chemotherapy. The
one group sort of in the middle, the intermediate risk recurrent scores, there is some debate
about what to do with those. Some medical oncologists may then use the KI67 sort of
tip them over saying well you know and based on another factors, I think this patient should
have chemotherapy. So, they are separate tasks, completely separate tasks, but they
can interact with each other and it's a really terrific question and I am glad that was asked.
Lisa Schneider-Cipriano: It almost seems like it's another opportunity to double check
if you will. You know like if you said if you are not the high risk with the Oncotype,
but you are in the middle there, like okay I am on the fence, am I going to go this way
or I am going to go this way and its like I had never heard of the KI67 so I am happy
to know the correlation and what that can do is well because of course I did the Oncotype
DX and I was a candidate for the chemo, but the more information again about everybody's
different treatment options and what's is available, this is huge.
Jay K. Harness, MD: Well it is. Actually KI67 has got around
for a long time. It has been used historically to again look at, in other words, if the cells
are turning over quickly, it means that probably the cancer is as I said more poorly differentiated,
it's a bad actor if you will and more likely than not, it is going to respond to chemotherapy.
Now, there have been studies done comparing KI67 with Oncotype directly and they don't
exactly correlate as far as the benefit of chemotherapy, but what this is, all of these
different tests Lisa help us to try and create a personalized plan for a patient and that's
what's really important here and the more data if you will, the more information that
we get, that helps us to individualize the treatment, the better we are
going to be.