By Jasmine Shukla & Laura Carfang
The results of the Oncotype DX is a recurrence score, a number which ranges from 1 through 100. The higher number is associated with a greater probability of the cancer returning and that the patient will receive greater benefits from undergoing chemotherapy. If the number is lower, studies have found that there is little added benefit of adding chemotherapy as part of the patients treatment plan.
These scores suggests the risks and chances of breast cancer’s return even after therapy and surgery. The result or outcome serves as a point of reference for a dialogue between the patient and the oncology team to determine the best course of action.
Oncotype DX Test
The Oncotype DX is a genomic test that analyses the behavior of 21 genes and, through an algorithm, predicts the likelihood of how effective chemotherapy would be for a particular individual.
We know there are several benefits of undergoing chemotherapy but the choice to put our bodies through such a potent and toxic treatment does not come easily. It's important for those diagnosed with breast cancer and their medical oncologists to discuss the pros and cons of a chemotherapy regimen, the timing of chemotherapy (neoadjuvant i.e., before surgery, or adjuvant meaning after surgery) and understand that it may not be for everyone.
A research study called "Trial Assigning Individualized Options for Treatment” (TAILORx) set out to determine whether chemotherapy is beneficial for women who have mid-range Oncotype DX tumor recurrence scores. This trial — the largest breast cancer treatment trial ever conducted— showed that endocrine therapy alone was as effective as endocrine therapy plus chemotherapy in women with certain types of early stage breast cancer. The results of this trial have been implemented immediately into practice after its announcement at the American Society of Clinical Oncology.
Oncotype dx Test - When is it used?
The Oncotype dx test is used in two main scenarios.
1. If the breast cancer has not spread beyond the milk ducts, (ductal carcinoma in situ), it will help doctors understand the woman's risk of the cancer coming back, or returning, as well as provide insight into the benefits the woman would receive from radiation therapy after DCIS surgery.
2. If the early stage cancer is estrogen-receptor positive, the oncotype dx test can help frame the conversation for how likely the woman would benefit from chemotherapy after surgery.
Who is eligible for the Oncotype DX Test?
This test isn't for everyone. When I found out about this news which came out in 2018, I was shocked that I didn't hear about it. The thought of not needing to have chemotherapy would have been my dream! But after looking more into who would be a likely candidate, I quickly came to realize it was not me since the cancer had spread to my lymph nodes.
Candidates for the Oncotype Dx Test:
You have recently been diagnosed with stage I or II invasive breast cancer
The cancer is estrogen-receptor-positive
There is no cancer in your lymph nodes (lymph-node-negative breast cancer)
You and your doctor are making decisions about chemotherapy.
The results of Oncotype DX test must be given its enormous significance and is to be conducted without any glitches as the consequence result leads to an essential decision about the effectiveness and recurrence. This test is a subjective one, as it will never be the same for any two people and predictions for each individual will be unique. This is to be done only after proper consultations by proficient medical specialists as the life of the patient is at risk and anything wrong or even one small mistake can have severe repercussions. ASCO has provided the latest guidelines and recommendations here.
High Oncotype Score
The American Society for Clinical Oncology and National Comprehensive Cancer Network Guidelines now include the ODRS in their treatment guidelines for early breast cancer. However, the test is expensive and costs approximately $4000 per patient in the United States.
Oncotype DX Recurrence Score Chart
Oncotype DX test recurrence scores (ODRS) are a way for oncologists and patients to discuss next steps in terms of a treatment plan. After looking at numerous charts, I have to say that the data is still very confusing. While it is easy to find information on how the Oncotype DX is scored, it is important to read the fine print which determine the charts.
Here is a general guideline with regards to low and high risk ODRS:
Score 0 to 17 is considered a Low recurrence score and the chance that your cancer will return is low. This score also suggests that the benefits of chemotherapy may not be worth the risks for you. However, please remember a low recurrence score does not mean that your cancer will definitely not come back.
Score 18 to 30 is considered a Medium recurrence score and the benefits of chemotherapy for you are uncertain. Your doctor will discuss with you what this means and take in all of the factors that are specific to your diagnosis and cancer characteristics.
A Score 31 to 100 is considered a High recurrence score. If you have a high recurrence score, the chance that your cancer will return is somewhat high and adding chemotherapy to your cancer treatment may help keep the cancer from coming back. It’s important to note that a high recurrence score does not mean that your cancer will definitely come back.
Oncotype DX Test Reliability
The Oncotype DX has a significant impact on decision making in adjuvant therapy recommendations. But the scoring system is not as black and white as it may seem. Age and stage play a significant role in interpreting these results. According to the TAILORx study, women 50 and younger with an Oncotype DX score of 16-25, there may be a benefit of including both hormone therapy and chemotherapy in the treatment plan. Similarly, a result of 39 for women who are stage 0 with DCIS are considered to have low risk for local recurrence and the benefits of radiation do not outweigh the risks.
It’s important to know that you may qualify for an Oncotype DX test and that the results are a starting point for a deeper conversation with your oncologist. Significant advancements are being made in the breast cancer community and an opportunity for us to limit the toxicity to which we expose ourselves. However, treatment plans are individual specific and at the end of the day, we have to do what is right for us and in line with our spirit.
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References
Dialani V, Gaur S, Mehta TS, Venkataraman S, Fein-Zachary V, Phillips J, et al. Prediction of low versus high recurrence scores in estrogen receptor-positive, lymph node-negative invasive breast cancer on the basis of radiologic-pathologic features: comparison with Oncotype DX test recurrence scores. Radiology. 2016;280:370–378.
Siow, Z. R., De Boer, R. H., Lindeman, G. J., & Mann, G. B. (2018). Spotlight on the utility of the Oncotype DX® breast cancer assay. International journal of women's health, 10, 89–100. doi:10.2147/IJWH.S124520
Sparano JA, Gray RJ, Makower DF, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 379(2):111-121, 2018.