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Comparison of Double and Triple High-Dose Chemotherapy with Autologous Blood Stem Cell Transplantation in Patients with Metastatic Breast Cancer

^a Department of Gynecology and Obstetrics, and
^b Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany;
^c Department of Hematology and Oncology, University of Düsseldorf, Düsseldorf, Germany

Key Words. Metastatic breast cancer • High-dose chemotherapy • Multiple cycle • Blood stem cell transplantation

Correspondence: Andreas Schneeweiss, M.D., University of Heidelberg, Department of Gynecology and Obstetrics, Vossstrasse 9, D-69115 Heidelberg, Germany. Telephone: 49-6221-567856; Fax: 49-6221-565233; e-mail: andreas_schneeweiss{at}med.uni-heidelberg.de  

In patients with metastatic breast cancer (MBC), early dose intensification with multiple cycles of peripheral blood stem cell-supported high-dose chemotherapy (HDCT) seems superior to a late dose-intensification strategy. We compared the progression-free survival (PFS) and overall survival (OS) of 20 patients treated with a double (D)-HDCT regimen to 20 patients who received a triple (T)-HDCT, matched by age, estrogen receptor (ER) status, adjuvant chemotherapy, initial disease-free interval, predominant metastatic site, and number of metastatic sites. At a median follow-up of 41.5 months (range, 14-88 months) an intent-to-treat analysis showed no difference in PFS (p = 0.72) and OS (p = 0.93) between the matched patients. For all 76 patients treated within the D- or T-HDCT trial, median PFS and OS was 13 months (range, 2-78 months) and 24.5 months (range, 7-78 months), respectively. In multivariate analysis independent predictors of shorter OS included negative ER (relative risk [RR] = 3.0 [95% confidence interval (CI) 1.5-5.9]; p = 0.002), more than two metastatic sites (RR = 2.4 [95% CI 1.0-5.7]; p = 0.049) and failure to achieve complete remission/no evidence of disease (CR/NED) after HDCT (RR = 4.5 [95% CI 2.0-10.1]; p < 0.0001). These data show that early dose intensification with T-HDCT is not superior to a D-HDCT regimen in patients with MBC. ER-negative tumors, more than two metastatic sites and no CR/NED after HDCT, are associated with inferior outcome.

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				A. Schneeweiss, M. Hensel, P. Sinn, T. Khbeis, R. Haas, G. Bastert, and A. D. Ho Characteristics associated with long-term progression-free survival following high-dose chemotherapy in metastatic breast cancer and influence of chemotherapy dose Ann. Onc., May 1, 2002; 13(5): 679 - 688. [Abstract] [Full Text] [PDF]

				M. Hensel, A. Schneeweiss, H.-P. Sinn, G. Egerer, M. Kornacker, E. Solomayer, R. Haas, G. Bastert, and A. D. Ho Stem Cell Dose and Tumorbiologic Parameters as Prognostic Markers for Patients with Metastatic Breast Cancer Undergoing High-Dose Chemotherapy with Autologous Blood Stem Cell Support Stem Cells, January 1, 2002; 20(1): 32 - 40. [Abstract] [Full Text] [PDF]