[High-dose chemotherapy in breast cancer].
BACKGROUND
The role of high-dose chemotherapy (HDCT) in primary and metastatic breast cancer remains controversial. Although results of several randomized trials have become available, the data is still inconclusive.
In the adjuvant setting, only one trial has shown an advantage in recurrence-free survival, whereas none of the randomized trials showed a significant improvement in overall survival.
In metastatic breast cancer, four of five randomized trials revealed a significant benefit in progression-free survival for patients treated with HDCT. However, differences in overall survival have not been observed.
Interpretation of the trials is limited due to a lack of statistical power in some of the trials, a relatively short follow-up, a relatively intensive chemotherapy regimen in the control arm, and an inappropriate selection of cytotoxic agents with only moderate activity and/or unacceptable toxicity.


CONCLUSIONS
Several questions, especially the approach of early intensification or tandem HDCT, have to be answered yet. The results of ongoing studies are urgently needed.
Schmid
Peter
P
Medizinische Klinik mit Schwerpunkt Onkologie und Hämatologie, Charite Campus Mitte, Humboldt-Universität Berlin, Germany. peter.schmid@charite.de
Possinger
Kurt
K
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D017024:Chemotherapy, Adjuvant; D017326:Clinical Trials, Phase III as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D013997:Time Factors
D000970:Antineoplastic Agents