Women treated for high-risk breast cancer with both standard- and high-dose chemotherapy with autologous stem cell transplants showed no improvement in relapse-free or overall survival compared with women who had standard chemotherapy.
The majority of women who have micrometastases when their breast cancer is diagnosed eventually die of their disease. Therefore, improved therapies are needed to increase the cure rates for such high-risk primary breast cancer. Gabriel Hortobagyi, M.D., of The University of Texas M. D. Anderson Cancer Center, and colleagues present their findings of a systemic approach in the February 2 issue of the Journal of the National Cancer Institute.
The high-risk women who participated in this study fell into two categories. The first had operable stage II or III primary breast cancer with 10 or more involved lymph nodes at the time of their surgery. The second had stage III or locally advanced breast cancer and four or more involved lymph nodes at surgery. The latter group received four cycles of standard chemotherapy before their surgery.
All 78 women in this study were scheduled to receive eight cycles of standard chemotherapy consisting of a combination of 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC). Half of the patients were scheduled to receive an additional two cycles of high-dose cyclophosphamide, etoposide, and cisplatin (FAC/high dose). To counter the destructive effects of the high-dose chemotherapy, women in this group also received stem cells extracted from their bone marrow or peripheral blood in addition to the high-dose chemotherapy. Tamoxifen was planned for all postmenopausal women, and radiation therapy was planned for all participants; however, not all of the 78 women completed all their treatments.
After a median follow-up period of 6.5 years, recurrence of breast cancer had occurred in 19 women in the FAC group and in 22 women in the FAC/high-dose group. Fourteen women in the FAC group and 17 in the FAC/high-dose group died of metastatic breast cancer. Calculated 3-year survival rates were 77% for the FAC group and 58% for the FAC/high-dose group. The incidence and severity of toxic reactions were higher in the FAC/high-dose group. No evidence was found of major survival differences between women receiving preoperative and postoperative chemotherapy.
The authors conclude that no relapse-free or overall survival advantage was associated with the use of high-dose chemotherapy, and morbidity was increased with its use. Therefore, the authors say that, at this time, high-dose chemotherapy is not indicated outside clinical trials.
Contact: Michael Courtney, The University of Texas M. D. Anderson Cancer Center, Houston, (713) 792-0655; fax (713) 794-4418.
Note: This memo to reporters is from the Journal staff and is not an official release of the National Cancer Institute (NCI) or Oxford University Press (OUP) nor does it reflect NCI or OUP policy. In addition, unless otherwise stated, all articles and items published in the Journal reflect the individual views of the authors and not necessarily the official points of view held by NCI, any other component of the U.S. government, OUP, or the organizations with which the authors are affiliated. Neither NCI nor any other component of the U.S. government nor OUP assumes any responsibility for the completeness of the articles or other items or the accuracy of the conclusions reached therein.
![]() |
||||
|
Oxford University Press Privacy Policy and Legal Statement |