Clinical impact of chemotherapy dose escalation in patients with hematologic malignancies and solid tumors.
OBJECTIVE
To review published controlled clinical trials examining the benefit of escalated chemotherapy in patients with hematologic and solid malignancies.


METHODS
Studies were obtained by searching Medline and CancerLit and by review of bibliographies of published trials. We reviewed studies that examined dose-intense (DI) chemotherapy alone, in combination with hematopoietic colony-stimulating factors (CSFs), or high-dose therapy (HDT) with autologous bone marrow support (ABMT).


RESULTS
DI therapy without CSF or ABMT has not been shown to improve overall outcome in any tumor except consolidative therapy of acute myelogenous leukemia (AML). In solid tumors, many published studies suggest that less than standard-intensity chemotherapy is suboptimal, but few studies that examined higher compared with standard-dose therapy have shown a significant difference in outcome. No studies have convincingly demonstrated improved overall survival (OS) with DI therapy with CSF support. The use of HDT with ABMT has been shown to improve survival in multiple myeloma (MM), as well as relapsed intermediate- and high-grade non-Hodgkin's lymphoma (NHL). High-dose chemotherapy with ABMT is promising in patients with metastatic breast cancer (MBC), but it should not yet be considered a standard approach for these patients.


CONCLUSIONS
DI chemotherapy is an acceptable and standard therapeutic maneuver for patients with AML in first remission, MM, and relapsed aggressive NHL. In solid tumors, the use of DI chemotherapy either alone or with cytokine support has not been shown to improve outcome and should not be considered standard therapy. Current randomized trials should provide definitive answers about the role of DI therapy in solid tumors.
Savarese
D M
DM
Division of Hematology/Oncology and the Cancer Center, University of Massachusetts Medical Center, Worcester 01655, USA. diane.savarese@bangate.ummed.edu
Hsieh
C
C
Stewart
F M
FM
D000970:Antineoplastic Agents / Q000008:administration & dosage*; D016026:Bone Marrow Transplantation; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000628:therapy; D016298:Hematopoietic Cell Growth Factors / Q000627:therapeutic use; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate
D000970:Antineoplastic Agents; D016298:Hematopoietic Cell Growth Factors