Onco DX Test Results

Yesterday (Friday) we met with Dr. Kaplan who gave us the results of Marce's Oncotype dx testing. This test provides us with the likelihood that her cancer will reappear with and without hormonal and/or chemotherapy. This website gives a good overview of the test.

http://www.genomichealth.com/oncotype/about/what.aspx

While the test scores were not bad, they weren't as good as we and Dr. Kaplan had hoped. Prior to yesterday's test results, Marce's "recurrence risk" was estimated to be:

Do Nothing 15% chance of cancer returning in her life
Hormonal Blocking Therapy (i.e. Tamoxifen) 8%
Hormonal + Chemotherapy 5-7%

Based on that, Marce was mentally gearing up to take Tamoxifen, but not thinking chemotherapy since it would only provide an insignificant benefit of 1-2%. The new numbers from the Onco DX testing are:

Do Nothing 30% chance of cancer returning in her life
Hormonal Blocking Therapy (i.e. Tamoxifen) 13%
Hormonal + Chemotherapy 8-10%

Dr. Kaplan said we are in the 'grey zone' in his thinking about whether to do chemo or not. He definitely recommends Tamoxifen, but the chemo decision is a personal risk decision about the small but significant improvement provided by chemo. Its the old trade study of short term pain vs. long term benefit. This has significantly changed things to the point where Marce is now strongly considering chemotherapy. If she does elect chemo, the good news is that the specific therapies Dr. Kaplan would recommend are the most mild forms of chemo. There are two choices she has, which are:

Opton 1 - CMF http://www.chemotherapy-info.com/cmf.htm
Pros
- The least side effects, with tiredness lasting about 1 week per month for 6 months
- Only 30% chance of losing her hair
Cons
- 6 month treatment

Option 2 - TC http://www.breastcancer.org/treatment/chemotherapy/new_research/20060217.jsp
Pros
- Tiredness is typically shorter, around 3 days, rather than 7
- Half the treatment duration as CMF
- Similar benefits to CMF
Cons
- High probability of hair loss
- Side effects can be tougher than CMF, although still mild for any chemo

The other thing Dr. Kaplan said is that if the cancer does come back, regardless of whether she does chemo now or not, then it will be very difficult to beat. If she is ever to do chemo, now is the most effective time. Given that she is relatively young, we want to maximize her longevity. Plus it will be easier for her to recover from chemo now than, say in 10 or 20 years if it were to reappear. So, with all of that, we are both currently thinking that the small but significant 3-5% improvement in survivability is worth 3 months of the relatively mild inconvenience of chemo side-effects. Additionally, we have found a great naturopathic doctor who specializes in cancer oncology, and he has given us some good information and supplements which will further help Marce's survival.

So, where we find ourselves today is that Marce will definitely do the Tamoxifen, which is 5 years following chemo. While still uncertain about the chemo, we are leaning that direction based on the above information. We would appreciate your prayers that God would give us wisdom and peace about whatever Marce finally decides.

Marc