title: 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.
abstract: 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.
authors.affiliation: University of Texas M.D. Anderson Cancer Center, Houston, 77030, USA. dberry@odin.mdacc.tmc.edu
authors.forename: Donald A
authors.initials: DA
authors.lastname: Berry
authors.forename: Gloria
authors.initials: G
authors.lastname: Broadwater
authors.forename: John P
authors.initials: JP
authors.lastname: Klein
authors.forename: Karen
authors.initials: K
authors.lastname: Antman
authors.forename: Joseph
authors.initials: J
authors.lastname: Aisner
authors.forename: Jacob
authors.initials: J
authors.lastname: Bitran
authors.forename: Mary
authors.initials: M
authors.lastname: Costanza
authors.forename: Cesar O
authors.initials: CO
authors.lastname: Freytes
authors.forename: Edward
authors.initials: E
authors.lastname: Stadtmauer
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.forename: I Craig
authors.initials: IC
authors.lastname: Henderson
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Philip L
authors.initials: PL
authors.lastname: McCarthy
authors.forename: Larry
authors.initials: L
authors.lastname: Norton
authors.forename: Howard
authors.initials: H
authors.lastname: Parnes
authors.forename: Andrew
authors.initials: A
authors.lastname: Pecora
authors.forename: Michael C
authors.initials: MC
authors.lastname: Perry
authors.forename: Philip
authors.initials: P
authors.lastname: Rowlings
authors.forename: Gary
authors.initials: G
authors.lastname: Spitzer
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
mesh_terms: 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