title: [High-dose chemotherapy with four drugs and peripheral blood progenitor cell autologous transplantation in disseminated breast cancer].
abstract: OBJECTIVE
  To evaluate the therapeutic efficacy (in terms of overall survival [OS] and progression-free survival [PFS]) of a high-dose chemotherapy protocol including four drugs and peripheral stem cell rescue (PSCR) plus posttransplant G-CSF (filgrastim) in disseminated breast cancer patients.
  
  
  METHODS
  Fifty-three metastatic breast cancer patients were treated with a four-drug program of high-dose chemotherapy including cyclophosphamide (6 g/m2), thiotepa (500 mg/m2), carboplatin (800-1,600 mg/m2) and mitoxantrone (20-60 mg/m2) with autologous peripheral blood progenitor cell support followed by filgrastim. Most cases (92%) had previously received conventional induction chemotherapy with anthracycline-containing combinations.
  
  
  RESULTS
  After a median follow-up of 27 months (range 12-43 months) from transplant, the median survival of the overall group was 25 months, with an OS projected at 43 months of 31%. Patients in complete remission after induction chemotherapy or status NED (no evidence of disease: surgical resection of metastases) presented the best outcome, with a projected PFS of 50% at 43 months. Patients intensified without complete response had a poor outcome. The most important extramedullary toxicity was mucositis. Four patients (7.5%) died as a consequence of treatment (2 with sepsis-associated ARDS, one with venooclussive disease of the liver, one with congestive cardiac failure).
  
  
  CONCLUSIONS
  The outcome of metastatic breast cancer patients in complete remission after induction chemotherapy or NED status seems to be good with our high-dose chemotherapy including four drug and PSCR. On the other hand, patients intensified without complete response presented a bad outcome and do not seem candidates for future trials with this therapeutic approach.
authors.affiliation: Servicio de Oncología Médica, Hospital Universitario San Carlos, Madrid. mmartin@skios.es
authors.forename: M
authors.initials: M
authors.lastname: Martín
authors.forename: A
authors.initials: A
authors.lastname: Casado
authors.forename: L
authors.initials: L
authors.lastname: Llorente
authors.forename: J A
authors.initials: JA
authors.lastname: López Martín
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez Lescure
authors.forename: Y
authors.initials: Y
authors.lastname: Nieto
authors.forename: F
authors.initials: F
authors.lastname: Ayala
authors.forename: J
authors.initials: J
authors.lastname: Pérez Calvo
authors.forename: J L
authors.initials: JL
authors.lastname: Alonso
authors.forename: C
authors.initials: C
authors.lastname: Pérez López
authors.forename: A
authors.initials: A
authors.lastname: Villegas
authors.forename: E
authors.initials: E
authors.lastname: Díaz-Rubio
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000628:therapy*; D016190:Carboplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D016019:Survival Analysis; D013852:Thiotepa / Q000008:administration & dosage; D014182:Transplantation, Autologous
chemical_list: D003520:Cyclophosphamide; D013852:Thiotepa; D016190:Carboplatin; D008942:Mitoxantrone
vernacular_title: Quimioterapia intensiva con cuatro fármacos y trasplante autogénico de células progenitoras de sangre periférica en el cáncer diseminado de mama.