Status of high-dose chemotherapy for breast cancer: a review.
The purpose of this review is to analyze the current status of high-dose chemotherapy (HDCT) with autologous stem cell transplantation for patients with breast cancer. Current results from the major prospective phase 2 and phase 3 trials in metastatic breast cancer (MBC) and high-risk primary breast cancer (HRPBC) are reviewed. Prognostic factors and future research directions are also discussed. The encouraging results of phase 2 trials suggested a benefit for HDCT in HRPBC and some categories of patients with MBC. Some investigators have argued that patient selection might have been a critical factor in those studies. Recently reported randomized trials in patients with chemosensitive MBC have included only small numbers of patients in complete remission and thus have not adequately addressed the relative value of HDCT versus maintenance standard-dose chemotherapy in this patient subset. Although initial results of 2 studies have been reported, most randomized phase 3 studies of HDCT in HRPBC require longer follow-up before definitive conclusions can be made about its efficacy in this setting. We conclude that the role of HDCT for HRPBC or MBC patients has not yet been fully defined. Longer follow-up of the ongoing randomized trials is necessary, and their mature results will help clarify this important question. In the meantime, it is imperative that research continues, to enhance the efficacy of the procedure. This may come through incorporating more active drugs into HDCT regimens and combining HDCT with novel strategies aimed at eradication of posttransplantation minimal residual disease.
Nieto
Y
Y
University of Colorado Bone Marrow Transplant Program, Denver 80262, USA. yago.nieto@uchsc.edu
Champlin
R E
RE
Wingard
J R
JR
Vredenburgh
J F
JF
Elias
A D
AD
Richardson
P
P
Glaspy
J
J
Jones
R B
RB
Stiff
P J
PJ
Bearman
S I
SI
Cagnoni
P J
PJ
McSweeney
P A
PA
LeMaistre
C F
CF
Pecora
A L
AL
Shpall
E F
EF
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis; D001855:Bone Marrow Diseases / Q000139:chemically induced / Q000628:therapy; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D002469:Cell Separation; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005602:France; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015993:Life Tables; D015337:Multicenter Studies as Topic; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D015143:Philadelphia; D011379:Prognosis; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D012107:Research Design; D012189:Retrospective Studies; D012306:Risk; D016879:Salvage Therapy; D016896:Treatment Outcome; D014481:United States
D014408:Biomarkers, Tumor