High dose chemotherapy : Rationale and results in breast carcinoma

✍ Scribed by Robert E. Coleman

• Publisher: John Wiley and Sons
• Year: 2000
• Tongue: English
• Weight: 101 KB
• Volume: 88
• Category: Article
• ISSN: 0008-543X
• DOI: 10.1002/1097-0142(20000615)88:12+<3059::aid-cncr24>3.0.co;2-h

✦ Synopsis

BACKGROUND.

High dose chemotherapy (HDC) with hematopoietic stem cell support is an increasingly important strategy in the management of advanced cancer.

Early Phase II studies and the development of peripheral blood stem cell support to enable safe and tolerable myeloablative chemotherapy has resulted in its controversial and widespread use in the management of breast carcinoma. Recently, several randomized trials of both advanced breast carcinoma and the adjuvant setting have been reported.

METHODS.

The technical developments in HDC and results from the randomized clinical trials reported to date were reviewed.

RESULTS.

Three randomized trials of advanced breast carcinoma and five of high risk adjuvant patients were identified. Only two relatively small trials from South Africa have so far shown an advantage for high dose chemotherapy, and the validity of these trials has recently been seriously challenged. A Scandinavian adjuvant trial showed no advantage for HDC when compared with maximum nonablative doses supported with granulocyte-colony stimulating factor (G-CSF).

Four trials were too small to detect clinically realistic differences in outcome, whereas the other large adjuvant trial was reported prematurely and the results in the HDC arm were dominated by high procedure-related mortality.