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J R Soc Med. 1996 June; 89(6): 337P–339P.
PMCID: PMC1295826

High dose chemotherapy for breast cancer: the case for trials in adjuvant therapy.

Abstract

Adjuvant polychemotherapy reduces the annual mortality for breast cancer, the effect being seen for at least the first decade after primary treatment for stage II disease. However, the overall benefit is modest with an annual reduction in the odds of death of the order of 20%-30%. For patients at standard or low risk of recurrence this appears to be an acceptable benefit given low toxicity of treatment. However, some patients have a very much worse prognosis identifiable on the basis of the number of involved axillary nodes at surgery. Patients with more than 10 lymph nodes, for example, have a predicted survival of less than 30% at 5 years and around 10% at 10 years. High dose chemotherapy has shown immediate benefits in terms of complete response rates in advanced breast cancer. Potential benefits of this treatment could be even higher in the adjuvant setting given the patient's fitness and the fact that micrometastatic disease represents the best clinical analogue of the successful laboratory experimental conditions. Now that the safety factors appear to be favourable with a treatment-related mortality of less than 5% it would appear that stage II poor risk disease is an appropriate setting to test high dose chemotherapy against the best conventional therapy in randomized trials.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer. 1989 Jan 1;63(1):181–187. [PubMed]
  • Teicher BA, Cucchi CA, Lee JB, Flatow JL, Rosowsky A, Frei E., 3rd Alkylating agents: in vitro studies of cross-resistance patterns in human cell lines. Cancer Res. 1986 Sep;46(9):4379–4383. [PubMed]
  • Teicher BA, Holden SA, Cucchi CA, Cathcart KN, Korbut TT, Flatow JL, Frei E., 3rd Combination of N,N',N"-triethylenethiophosphoramide and cyclophosphamide in vitro and in vivo. Cancer Res. 1988 Jan 1;48(1):94–100. [PubMed]
  • Hryniuk W, Levine MN. Analysis of dose intensity for adjuvant chemotherapy trials in stage II breast cancer. J Clin Oncol. 1986 Aug;4(8):1162–1170. [PubMed]
  • Antman KH, Souhami RL. High-dose chemotherapy in solid tumours. A review of published data in selected tumours with a commentary. Ann Oncol. 1993;4 (Suppl 1):29–44. [PubMed]
  • Bonadonna G, Valagussa P. Dose-response effect of adjuvant chemotherapy in breast cancer. N Engl J Med. 1981 Jan 1;304(1):10–15. [PubMed]
  • Eddy DM. High-dose chemotherapy with autologous bone marrow transplantation for the treatment of metastatic breast cancer. J Clin Oncol. 1992 Apr;10(4):657–670. [PubMed]
  • Wood WC, Budman DR, Korzun AH, Cooper MR, Younger J, Hart RD, Moore A, Ellerton JA, Norton L, Ferree CR, et al. Dose and dose intensity of adjuvant chemotherapy for stage II, node-positive breast carcinoma. N Engl J Med. 1994 May 5;330(18):1253–1259. [PubMed]
  • Norton L, Simon R. The Norton-Simon hypothesis revisited. Cancer Treat Rep. 1986 Jan;70(1):163–169. [PubMed]
  • Shpall EJ, Jones RB, Bearman SI, Franklin WA, Archer PG, Curiel T, Bitter M, Claman HN, Stemmer SM, Purdy M, et al. Transplantation of enriched CD34-positive autologous marrow into breast cancer patients following high-dose chemotherapy: influence of CD34-positive peripheral-blood progenitors and growth factors on engraftment. J Clin Oncol. 1994 Jan;12(1):28–36. [PubMed]
  • Peters WP, Ross M, Vredenburgh JJ, Meisenberg B, Marks LB, Winer E, Kurtzberg J, Bast RC, Jr, Jones R, Shpall E, et al. High-dose chemotherapy and autologous bone marrow support as consolidation after standard-dose adjuvant therapy for high-risk primary breast cancer. J Clin Oncol. 1993 Jun;11(6):1132–1143. [PubMed]
  • Ross AA, Cooper BW, Lazarus HM, Mackay W, Moss TJ, Ciobanu N, Tallman MS, Kennedy MJ, Davidson NE, Sweet D, et al. Detection and viability of tumor cells in peripheral blood stem cell collections from breast cancer patients using immunocytochemical and clonogenic assay techniques. Blood. 1993 Nov 1;82(9):2605–2610. [PubMed]
  • Leonard RC. High-dose chemotherapy for metastatic breast cancer. Lancet. 1994 Oct 15;344(8929):1084–1084. [PubMed]
  • de Graaf H, Willemse PH, de Vries EG, Sleijfer DT, Mulder PO, van der Graaf WT, Smit Sibinga CT, van der Ploeg E, Dolsma WV, Mulder NH. Intensive chemotherapy with autologous bone marrow transfusion as primary treatment in women with breast cancer and more than five involved axillary lymph nodes. Eur J Cancer. 1994;30A(2):150–153. [PubMed]

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