title: Randomized trial of high-dose adjuvant chemotherapy with autologous hematopoietic stem-cell support versus standard-dose chemotherapy in breast cancer patients with 10 or more positive lymph nodes: overall survival after 6 years of follow-up.
abstract: Investigation of high-dose chemotherapy (HD-CT) compared with standard-dose chemotherapy (SD-CT) as adjuvant treatment in patients with primary breast cancer and >/=10 axillary lymph nodes. From November 1993 to September 2000, 307 patients were randomized to receive after four cycles of epirubicin (90 mg/m(2)), cyclophosphamide (600 mg/m(2)) i.v. (every 21 days) and either HD-CT of cyclophosphamide (1500 mg/m(2)), thiotepa (150 mg/m(2)) and mitoxantrone (10 mg/m(2)) i.v. for four consecutive days followed by stem cell transplantation or a SD-CT of three cycles CMF (cyclophosphamide 500 mg/m(2), methotrexate 40 mg/m(2), 5-fluorouracil 600 mg/m(2), i.v. on day 1 and 8, respectively, every 28 days). After a median follow-up of 6.1 years, 166 events with respect to event-free survival (EFS) (SD-CT: 91, HD-CT: 75) have been observed. The hazard ratio of HD-CT versus SD-CT is estimated as 0.80 [95% confidence interval (0.59, 1.08)], P = 0.15. The trend to a superiority of HD-CT as compared with SD-CT with respect to EFS seems to be more pronounced in premenopausal patients as compared with postmenopausal patients and in patients with tumor grade 3 as compared with patients with tumor grade 1/2. With a follow-up of 6 years, there was a trend in favor of HD-CT with respect to EFS not being significant. A proper meta-analysis needs to be undertaken for an evaluation of subgroups of patients who might benefit from HD-CT.
authors.affiliation: Center of Oncology, Clinic for Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: A R
authors.initials: AR
authors.lastname: Zander
authors.forename: C
authors.initials: C
authors.lastname: Schmoor
authors.forename: N
authors.initials: N
authors.lastname: Kröger
authors.forename: W
authors.initials: W
authors.lastname: Krüger
authors.forename: V
authors.initials: V
authors.lastname: Möbus
authors.forename: N
authors.initials: N
authors.lastname: Frickhofen
authors.forename: B
authors.initials: B
authors.lastname: Metzner
authors.forename: W E
authors.initials: WE
authors.lastname: Berdel
authors.forename: M
authors.initials: M
authors.lastname: Koenigsmann
authors.forename: E
authors.initials: E
authors.lastname: Thiel
authors.forename: H
authors.initials: H
authors.lastname: Wandt
authors.forename: K
authors.initials: K
authors.lastname: Possinger
authors.forename: R
authors.initials: R
authors.lastname: Kreienberg
authors.forename: M
authors.initials: M
authors.lastname: Schumacher
authors.forename: W
authors.initials: W
authors.lastname: Jonat
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D009367:Neoplasm Staging; D011446:Prospective Studies; D016019:Survival Analysis; D013852:Thiotepa / Q000008:administration & dosage; D014182:Transplantation, Autologous
chemical_list: D003520:Cyclophosphamide; D013852:Thiotepa; D008942:Mitoxantrone