Tip:
Highlight text to annotate it
X
The oncotype DX test has provided us with a recurrent score that gives us a lot of information
about what to do with patients, but there is a gray zone with the oncotype DX recurrent
score and that is a recurrence score between 18 and 30 called the intermediate range.
I have tried to share in the past the oncotype DX score is a continuum, if you will, of the
aggressiveness or the biology of a cancer from a very low recurrent score under 18 to
a more aggressive current score at 31 or higher. And so one of the great questions has been
what do we do with the intermediate range recurrent score and should those patients
have chemotherapy?
Well, the definitive answer for this is going to come in the future as a result of a very
large clinical trial that was closed, I think, about a year so ago and unfortunately, we
are going to have to wait for the results of that trial. So what do we do in the meantime?
Well this is a good example of why somebody needs to be working with a multidisciplinary
team, a team who really understands the new answers of breast cancer and can help any
patient make a decision about this intermediate range, so that other things would come to
play if we look at this continuum of aggressiveness, if you will, or the biology of breast cancer
within the zone of patient’s age, tumor size, grade, the sort of the historical things
that we have talked about in the past. Quite frankly, patient preference comes in here.
This is one of the wonderful aspects of oncotype DX because we share this test result with
patients, which helps to empower them to join in with the medical oncologist in making a
final decision.
So, it is true intermediate score is sort of a gray zone if you are on a really lower
end of that intermediate range have a small tumor, although a variety of really good things
going on, then more likely than not, you are not going to need chemotherapy, but again
this is a decision that has to be made with your medical oncologist.
Conversely, if you on a higher end of the intermediate score range, then more likely
than not, probably would benefit depending on other factors now from chemotherapy. So
there is no one absolute answer to the question about the patient who is right in the middle
of the intermediate risk score, we want to look at other things such as results of adjuvant
online, again all the other factors about the patient in order to make a final decision,
please as always be working with a multidisciplinary team.