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SharonP View Drop Down
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    Posted: 01 Feb 2012 at 7:55pm

Yesterday I called my doctor to find out my ki67 score because I was curious.  Several people have posted their score on here, and I wasn't told mine so I thought I would find out.  When I talked to the nurse she was very nice, but seemed a little apprehensive to tell me, she said she wanted to go talk to the doctor first and call me back. Well she called me right back and said that my ki67 was 98%.  Yikes!  That was not what I was expecting, I knew it would probably be high, but I wasn't expecting it to be that high.  I guess what bothers me even more is that even with a 98%, I still didn't have a complete resonse to the chemo.  My tumor went from 2.7cm to 1.3cm, which is just a little over half.  I would have just thought that with the score being so high the chemo would have completely eliminated the tumor.

Not sure what to think. 
age-42 DX 3-21-2011 w/IDC, TNBC,Grade 3, BRCA1+, 2.7 cm tumor w/necrosis,ki67-98%, 0/3 nodes, neoadj. chemo 4 DD AC & 4 DD Taxol. Bi-lat. mast.- 8/11(1.3cm residual tumor) Hyst.-9/11 Reconst.-10/11
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Lee21 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lee21 Quote  Post ReplyReply Direct Link To This Post Posted: 01 Feb 2012 at 8:13pm
There are some studies showing that Ki67 is an independent prognosticator -- I think the most important question is what was the Ki67 of your surgical specimen after neoadjuvant therapy?
12/9/11 @59,IDC,grade3, TNBC,3cm(MRI),SLNB0,stage IIA, BRCA1 variant
1/30/12 DD AC-T, 6/7/12 Lumpectomy, ypT1b(0.8 cm), 7/9/12 Rads x 30
11/9/12, clinical trial cisplatin/rucaparib, cisplatin-only arm
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dmwolf View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote dmwolf Quote  Post ReplyReply Direct Link To This Post Posted: 01 Feb 2012 at 8:14pm
A lot of TNs are high grade with super-high Ki67.  Actually, most might be like that.  I don't know what that says about how to interpret your residual disease.  There is more to chemo-response than proliferation, though proliferation seems to be a prerequisite. 

Try not to make yourself crazy (easier said than done, I know).  

DX 2/08@43 stg II IDC; gr2,0 nodes. Neoadj chemo, first ACx2 (fail) then CarboTaxotereX6(better). Lump, Rads done 11/08; Clodronate. False alarm queen: PetCT lung & TM marker. NED. PBM w/recon 9/10.
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debB View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote debB Quote  Post ReplyReply Direct Link To This Post Posted: 01 Feb 2012 at 9:35pm
Hi Sharon,

I never received a Ki67 on either of my pathologies. I went for a second opinion with a guy who is a TN expert and he wasn't concerned about it at all. He said that by the very nature of TNBC you (we) can expect a high score and that as fast as my tumor was growing it was likely very high. I know some studies indicate the high scores can be predictive of outcome or recurrence, but we already know that the insidious nature of TN already gives us that disadvantage. Don't know which came first here, the chicken or the egg!

From some of the reading that I did while awaiting my BRCA testing, I seem to recall (but not sure how accuarately!) that those who test positive don't respond as well to chemo but still have a better overall outcome. Someone please chime in if I am not recalling that correctly! Please forgive me, I have had chemo between now and then!

Deb


Dx 4/29/11, 46 yrs old, 3.9 cm tumor, Stg 2 Grade 3 chemo 4 rounds DD AC, 12 weekly taxol, finish. Lumpectomy, 2mm residual tumor. 37 rounds rads completed. Cisplatin/PARP trial
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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: 01 Feb 2012 at 9:46pm
When I asked my surgeon about my Ki67 score, she just said anything over 20% is high.  I guess it's all relative.  Mine was 48%, but I still had a recurrence.  You'll see women who have 99% with no recurrence.  I've given up trying to understand this disease!

Uncontrolled proliferation is a hallmark of cancer. In breast cancer, immunohistochemical assessment of the proportion of cells staining for the nuclear antigen Ki67 has become the most widely used method for comparing proliferation between tumor samples. Potential uses include prognosis, prediction of relative responsiveness or resistance to chemotherapy or endocrine therapy, estimation of residual risk in patients on standard therapy and as a dynamic biomarker of treatment efficacy in samples taken before, during, and after neoadjuvant therapy, particularly neoadjuvant endocrine therapy. Increasingly, Ki67 is measured in these scenarios for clinical research, including as a primary efficacy endpoint for clinical trials, and sometimes for clinical management. At present, the enormous variation in analytical practice markedly limits the value of Ki67 in each of these contexts. 

What is Ki-67?

An antigen is a protein that sits on the surface of a cell and stimulates the production of an antibody. Ki-67 is an antibody marker to a tumor antigen that can be found in breast cancer cells.

If your tumor is tested for Ki-67, your pathology report will show a Ki-67 score. High scores—greater than 20%—mean that the cancer cells are growing and dividing at a rapid pace.

Higher-grade tumors typically have a higher Ki-67 score. However, there is no conclusive evidence that Ki-67 is associated with survival. Some studies have found that it is; others have found that it is not.
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED8/12,CT NED 11/13

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SharonP View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote SharonP Quote  Post ReplyReply Direct Link To This Post Posted: 01 Feb 2012 at 10:07pm
Thank you everyone! I appreciate the information.  Everyone is always so helpful and nice on this forum.  Thanks again! 
age-42 DX 3-21-2011 w/IDC, TNBC,Grade 3, BRCA1+, 2.7 cm tumor w/necrosis,ki67-98%, 0/3 nodes, neoadj. chemo 4 DD AC & 4 DD Taxol. Bi-lat. mast.- 8/11(1.3cm residual tumor) Hyst.-9/11 Reconst.-10/11
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Charlene Quote  Post ReplyReply Direct Link To This Post Posted: 01 Feb 2012 at 10:43pm
I read that low Ki67 scores are LESS likely to be responsive to chemo than high scores.  My oncologist didn't place much weight on them regarding recurrence risk, etc.  I agree with Donna that there is simply no understanding a lot of this.  No hard and fast rules.
Charlene
DX 3/10 @59 ILC/TNBC
Stage 1, Grade 2, Multifocal; Lumpectomy/re-excision
SNB 0/4 nodes, BRCA-; Taxotere/Cytoxan X4, 30 rads
3/13: Mammo/ultrasound/breast MRI--NED;
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SharonP View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote SharonP Quote  Post ReplyReply Direct Link To This Post Posted: 01 Feb 2012 at 11:25pm
Charlene,
I also read that low ki67 scores are less responsive to chemo because it indicates a slow growing tumor.  So a high ki67 score indicates a fast growing tumor which should indicate that it would be very responsive to chemo.  That's why it concerns me that my tumor wasn't completely eliminated by the chemo. 
But I agree with you and Donna, it's impossible to try to make sense out of all of this.
Sharon 
age-42 DX 3-21-2011 w/IDC, TNBC,Grade 3, BRCA1+, 2.7 cm tumor w/necrosis,ki67-98%, 0/3 nodes, neoadj. chemo 4 DD AC & 4 DD Taxol. Bi-lat. mast.- 8/11(1.3cm residual tumor) Hyst.-9/11 Reconst.-10/11
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Post Options Post Options   Thanks (0) Thanks(0)   Quote mindy555 Quote  Post ReplyReply Direct Link To This Post Posted: 09 Feb 2012 at 12:15am
Sharon-  My initial pathology report from 4 core needle tissue samples revealed a KI67 score of 98%.  Neither of my oncologist put much emphasis on it.  My path also showed necrosis and I'm BRCA positive.  I read of a young woman here with the same KI67 score who was 11 years out NED.

Too many unknowns with TN and also very rare metaplasia which appears to make me more chemo resistant.  I expect to have residual disease... not pessimism, rather being realistic since my mass is about the same size it was at diagnoses.  I plan to get more opinions and be as aggressive after bilateral mastectomy as possible.  TN can play so dirty, I have no choice.

I wish you all the best Sharon. Thumbs Up
Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012
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ds21 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote ds21 Quote  Post ReplyReply Direct Link To This Post Posted: 09 Feb 2012 at 8:24am
My wife's oncologist had a similar opinion.  We asked about ki67 staining and she said, she could tell from the histology that it was going to be high and knowing a precise score would not alter treatment plans.

David
Co-survivor
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Post Options Post Options   Thanks (0) Thanks(0)   Quote TriplePositiveGirl Quote  Post ReplyReply Direct Link To This Post Posted: 14 May 2012 at 8:23pm
Hi all,

I know this is a late post to this topic, but it got me thinking about my own score. One thing interesting that I noted was at the time of my biopsy, my score was 50. After going through 4 rounds of gemzar/carbo PRIOR to my surgery, my ki-67 score at the time of the surgery had dropped to 15. My overall tumor grade was a 2 - moderate. My tumor shrunk about 50 to 60% with the chemo prior to surgery so it was not a complete response, but it DEFINITELY slowed the rate of growth of the cells....I would like to think that this means something positive (in a world of all negatives...no pun intended). Did anyone else who had chemo prior to their surgeries check to see if their ki-67 scores dropped? It's quite possible! If I hadn't gone back to look at my path reports I never would have noticed this!
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mindy555 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote mindy555 Quote  Post ReplyReply Direct Link To This Post Posted: 14 May 2012 at 9:40pm
TriplePositiveGirl,

I had neoadjuvant chemo, although post surgical pathology didn't report the KI-67.    It was either 98 or 99% on original diagnoses path.  I remember thinking.. "oh great" (w/heavy sarcasm).   Being aggressive with a high proliferation rate, the mass thankfully was responsive to chemo  (also Stage II after being Stage I (barely) @ 1.88 cm when first dx'ed).  I should say responsive when on the *right* chemo cocktail.  What little I felt at time of surgery was an empty tumor bed with slight scar tissue.

I've seen both ... here and on breastcancerdotorg.  Some have an actual increased KI-67 & some decreased.  As I mentioned earlier, the docs I consulted didn't put much clinical significance on the KI-67.. rather the end-line residual and node involvement. But, perhaps some do.

Edited by mindy555 - 14 May 2012 at 9:56pm
Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012
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TriplePositiveGirl View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote TriplePositiveGirl Quote  Post ReplyReply Direct Link To This Post Posted: 14 May 2012 at 9:57pm
Hi Mindy,

My doctors NEVER commented or mentioned my scores to me - so apparently it must not have been that important to them! I recently decided to go back and check my path reports to see if I was tested. It's so hard to know what to make of any of this since everything seems so random. I have been finished with my treatment for a year and a half now and I am now more concerned than ever with recurrence odds. I am reading up on things more and more, maybe I am worrying myself needlessly. This disease really stinks the way it messes with your mind! Thanks for responding to my post too...:)
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Post Options Post Options   Thanks (0) Thanks(0)   Quote KarenC Quote  Post ReplyReply Direct Link To This Post Posted: 16 May 2012 at 3:12pm
My K167 was lower than usual for people with TNBC according to my onc, and I seem to recall her saying that was unusual but it happened sometimes.  I had residual cancer after chemo but my tumor and nodes did show response and scarring from the chemo so that was encouraging.   My Ki67 changed slightly too after chemo but remained very low. KarenC
2/25/11 BX Lft SNode/TN.Trial of Gemzar/Carb/Parp 3/31-6/31.BMX
7/11.Clear mrgns,6/30 nodes.TaxolX12,DD A/CX4 done1/3/12.25 Rads/Xeloda/bolus pad done 2/28/12.PET-7/12

BRCA-Ki6720%.Stg111a,gr3,RCB3
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mindy555 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote mindy555 Quote  Post ReplyReply Direct Link To This Post Posted: 20 May 2012 at 5:07pm
TripleNegGirl & Karen-

Neither my local onc. or MDA onc. put "ANY" significance on the KI67.  From what I've read, most onc. don't.   SO...   I wouldn't worry over this aspect of pathology.  Instead try to place your energy towards a healthy lifestyle 'in the now.' 

I hope that doesn't sound preachy...  I absolutely worry over things others might find less than "worry-worthy"..  if that makes any sense.  I'm dealing with residual chemo-brain from hell.   lol




Edited by mindy555 - 20 May 2012 at 5:16pm
Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012
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steve View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote steve Quote  Post ReplyReply Direct Link To This Post Posted: 20 May 2012 at 5:37pm
Several years ago I had the pleasure of meeting Prof/Dr. Ian Smith from Royal Marsden Cancer Center in London. We had a long talk and I think he is a very knowledgeable Breast Medical Oncologist.

I think the following paper is an interesting perspective on KI67. 


I know some oncologists, whose opinion I value, who do use the KI67 score as a factor to be considered in a treatment plan. And I am not saying the oncologists who don't use it are wrong...just that some use it.

warmly,

Steve 
I am a BRCA1(187delAG)+ grandson, son and father of women affected by breast/oc-my daughter, inherited the mutation from me, and at age 36, was dx 2004 TNBC
75%invasive quandrantectomy,PBM,LAVH/BSO
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