Reviewers: Li Liu, MD
Source: Journal of the National Cancer Institute, Volume 92, No.3 (February):225-233, 2000
In patients with high-risk breast carcinoma some studies have suggested that high-dose chemotherapy (HDC) and autologous hematopoietic stem cell support (AHSCS) improved tumor response rates compared with conventional-dose chemotherapy. In addition, better supportive care measures have dramatically reduced morbidity and mortality due to HDC. However, whether HDC- AHSCS will improve overall survival in patients with high-risk breast cancer remains an open question. Dr. Gabriel N. Hortobagyi and colleagues from The University of Texas M. D. Anderson Cancer Center in Houston reported this randomized trial comparing standard combination chemotherapy versus the same therapy followed by high-dose consolidation chemotherapy with AHSCS for patients with high-risk breast cancers.
A total of 78 breast cancer patients who had either 10 or more positive lymph nodes after primary surgery or four or more positive lymph nodes after four cycles of induction chemotherapy were included. All patients received eight cycles of 5-FU, adriamycin, and cyclophosphamide (FAC) chemotherapy. Half of the patients were randomly assigned to receive, in addition, two cycles of cyclophosphamide, etoposide, and cisplatin with AHSCS. Postmenopausal women with estrogen receptor-positive tumors also received tamoxifen. All patients received radiation treatment.
In this study, the addition of high-dose chemotherapy and AHSCS to standard chemotherapy did not increase survival in high-risk breast cancer patients and in fact was associated with greater toxicity. There might be a subgroup of patients with high-risk breast cancers who will benefit from high-dose chemotherapy and AHSCS. However, to date, this group of patients has not been identified.