Combination chemotherapy for breast cancer metastatic to bone marrow.
Seventy-nine patients with metastatic breast cancer underwent examination of their bone marrow as part of their staging workup. Thirty-one (39%) showed no evidence of bone marrow involvement (BM-); 48 (61%) were found to have bone marrow metastases (BM+). Both groups of patients were treated with intensive chemotherapy with 5-FU, Adriamycin, cyclophosphamide, methotrexate, and nonspecific immunotherapy with BCG, methanol extraction residue, or Levamisole. The groups were comparable in age, race, menopausal status, and disease-free interval; however, the BM+ group had a higher proportion of patients with dominant osseous disease and a somewhat lower overall tumor burden. Ten of 21 patients in the BM+ group treated with 100% of the calculated dose of chemotherapy are still alive, compared with only three of 27 patients treated with lower doses. A similar dose response was observed in the BM- group. Myelosuppression was more common and more severe in the BM+ group. Hematologic support, i.e., packed erythrocytes and platelet transfusions, was required in 60% of BM+ patients, as opposed to 26% of BM-. Infectious complications were also higher in the BM+ group, in which five episodes of sepsis and two infectious deaths were observed. These results suggest that metastatic breast cancer patients with bone marrow invasion achieve excellent palliation with aggressive high-dose chemotherapy. Higher morbidity requiring aggressive supportive care suggests that these patients should be treated by physicians and centers experienced in their management.
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001424:Bacterial Infections / Q000150:complications; D001855:Bone Marrow Diseases / Q000188:drug therapy*; D001943:Breast Neoplasms / Q000401:mortality; D004359:Drug Therapy, Combination; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009503:Neutropenia / Q000139:chemically induced; D013921:Thrombocytopenia / Q000139:chemically induced
D000970:Antineoplastic Agents