title: Sequential high-dose alkylating therapy and stem cell support for high-risk stage III breast cancer.
abstract: Patients who receive neoadjuvant chemotherapy for locally advanced breast cancer and have four or more ipsilateral axillary lymph nodes involved at surgery are at high risk for recurrence, with a median time to relapse of 18 months. We offered such patients high-dose chemotherapy with stem cell rescue. Patients received cyclophosphamide or paclitaxel and granulocyte colony-stimulating factor (G-CSF) to mobilize stem cells. Melphalan 140 mg/m2 was then given with stem cell rescue. Twenty-four to 35 days later, thiotepa 900 mg/m2 was given with stem cell rescue. Patients with hormone receptor-positive tumors received tamoxifen. We treated 14 patients in this fashion from 1995 to 1998. The mean age was 46.7 years. The majority of cancers were stage IIIB (79%). Thirteen women underwent mastectomy after anthracycline-containing chemotherapy and 50% had more than seven positive lymph nodes. Hospitalization was principally for neutropenic fever. Other morbidities were pneumonitis, cardiomyopathy, and grade 3/4 white blood cell (WBC) toxicity. No patient died of a treatment-related complication. Seven of 14 relapsed at 10, 12, <15, 15, 17, 21, and 36 months, with median follow-up of 26.5 months. Time to relapse in this small series is only modestly improved over historical experience with standard-dose adjuvant chemotherapy. Alternative strategies for treating locally advanced breast cancer should be pursued.
authors: Bridgeport Hospital, Bridgeport, Connecticut, USA.
authors: Josette
authors: J
authors: Bou-Khalil
authors: Michal
authors: M
authors: Rose
authors: Amanda
authors: A
authors: Psyrri
authors: Elizabeth
authors: E
authors: D'Andrea
authors: Erin
authors: E
authors: Medoff
authors: Carol
authors: C
authors: Staugaard-Hahn
authors: Christine
authors: C
authors: Holtkamp
authors: Susan
authors: S
authors: Gran
authors: John
authors: J
authors: Pezzimente
authors: Edward
authors: E
authors: Snyder
authors: Dennis
authors: D
authors: Cooper
authors: Bruce
authors: B
authors: Haffty
authors: Michael
authors: M
authors: Reiss
authors: Barbara
authors: B
authors: Burtness
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D003237:Connecticut; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D010166:Palliative Care; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D016179:Granulocyte Colony-Stimulating Factor; D003520:Cyclophosphamide; D017239:Paclitaxel