[Dose intensification of adjuvant chemotherapy in high-risk non-metastatic breast cancer: a critical review].
Dose intensification with or without hematopoietic support, tries to overcome resistance of breast cancer to conventional treatment. Rationale of this approach mainly is: (1) the existence of a dose response and/or a dose-intensity-effect relationships; (2) the selection of high-risk and chemosensitive patient population, with a low tumor burden at the time of dose intensification. Progress in supportive therapy has reduced the toxicity of dose intensification. The apparent benefit observed in pilot studies may be, in part, due to patient selection bias and definitive evaluation of the efficacy has to be addressed by prospective controlled trials. This article overviews rationale, main therapeutic results and future prospects with a critical viewpoint.
Ganem
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Centre Jean-Bernard, Le Mans, France.
D000368:Aged; D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D019008:Drug Resistance, Neoplasm; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D066298:In Vitro Techniques; D008207:Lymphatic Metastasis; D015674:Mammary Neoplasms, Animal / Q000188:drug therapy* / Q000473:pathology; D051379:Mice; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011817:Rabbits; D051381:Rats; D016019:Survival Analysis; D016896:Treatment Outcome