High-dose versus standard chemotherapy in metastatic breast cancer: comparison of Cancer and Leukemia Group B trials with data from the Autologous Blood and Marrow Transplant Registry.
OBJECTIVE
To assess survival of patients with metastatic breast cancer treated with high-dose chemotherapy (HDC) versus standard-dose chemotherapy (SDC).


METHODS
SDC in four Cancer and Leukemia Group B (CALGB) trials was compared with hematopoietic stem-cell support in patients from the Autologous Blood and Marrow Transplant Registry. Cox proportional hazard regression incorporated potentially confounding effects. A total of 1,509 women were enrolled onto CALGB trials, and 1,188 women received HDC. No significant survival differences existed by CALGB trial or HDC regimen. Consideration was restricted to candidates for both SDC and HDC. The resulting sample included 635 SDC and 441 HDC patients. The outcome of interest was overall survival.


RESULTS
The HDC group displayed better performance status. The SDC group had slightly better survival in first year after treatment. The HDC group had lower hazard of death from years 1 to 4 and had somewhat higher probability of 5-year survival (adjusted probabilities [95% confidence intervals], 23% [17% to 29%] v 15% [11% to 19%], P =.03).


CONCLUSIONS
After controlling for known prognostic factors in this nonrandomized analysis of two large independent data sets, women receiving HDC versus SDC for metastatic breast cancer have a similar short-term probability of survival, and might have a modestly higher long-term probability of survival.
Berry
Donald A
DA
University of Texas M.D. Anderson Cancer Center, Houston, 77030, USA. dberry@odin.mdacc.tmc.edu
Broadwater
Gloria
G
Klein
John P
JP
Antman
Karen
K
Aisner
Joseph
J
Bitran
Jacob
J
Costanza
Mary
M
Freytes
Cesar O
CO
Stadtmauer
Edward
E
Gale
Robert Peter
RP
Henderson
I Craig
IC
Lazarus
Hillard M
HM
McCarthy
Philip L
PL
Norton
Larry
L
Parnes
Howard
H
Pecora
Andrew
A
Perry
Michael C
MC
Rowlings
Philip
P
Spitzer
Gary
G
Horowitz
Mary M
MM
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D016016:Proportional Hazards Models; D015996:Survival Rate