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  • Jay K. Harness: Will all lymph node positive patients benefit from chemotherapy? Not exactly.

  • Let me share some more about this important subject.

  • Lymph node positive breast cancer that means the cancer has spread from breast itself to

  • the lymph nodes in the armpit area. Now, historically, this was really an important factor in determining

  • if patients needed chemotherapy or not. Historically, the size of the cancer, the grade of the cancer,

  • but particularly, if the cancer was involving lymph nodes that meant that you would automatically

  • get chemotherapy and in premenopausal women probably one of big benefits of chemotherapy

  • has been knocking out the ovaries at least temporarily, so the question then becomes

  • do all patients who are lymph node positive have to have chemotherapy and as I have said,

  • not exactly. This is particularly true in the estrogen receptor-positive patients who

  • may have anywhere from one to three positive lymph nodes. The Oncotype DX test has been

  • validated for lymph node positive estrogen receptor-positive patients with a maximum

  • of three positive lymph nodes. Now, all of us in the field have known for years that

  • chemotherapy may not work that well in estrogen-receptor positive patients, but we have given the chemotherapy

  • anyway. Now for patient who is triple negative or HER2-neu positive or things like that,

  • no question that chemotherapy is really important, but in the lymph node positive patients, the

  • estrogen-receptor positive patients, the Oncotype score, the recurrence score can help us in

  • start to differentiate who is going to benefit from adjuvant chemotherapy. With a low risk

  • Oncotype score, the validation studies that have been done showed no benefit of adjuvant

  • chemotherapy up to three positive lymph nodes being involved and in the high-risk patients,

  • those who have a high risk recurrence score, there is no question that chemotherapy is

  • needed and that the patients benefit from it. With the intermediate risk score in the

  • middle, then here other clinical factors will come into play determining the role of adjuvant

  • chemotherapy, so the bottom-line of all this says if you are lymph node positive, do not

  • automatically think that you need chemotherapy whether you are pre or postmenopausal, make

  • sure that an Oncotype test is done if you are estrogen receptor-positive. You may be

  • able to avoid unnecessary chemotherapy, in particular chemotherapy that may not actually

  • benefit you.

  • Michael Alvarado: Did you know that not every breast cancer patient needs chemotherapy?

  • In fact today, there is a way to identify whether or not you would benefit from that

  • chemotherapy based on the biology of your tumor. To learn more about the Oncotype DX

  • assay and how to discuss the results with your physician, just press this button.

Jay K. Harness: Will all lymph node positive patients benefit from chemotherapy? Not exactly.

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