Affiliation:
1. From the Bone Marrow Transplantation, University Hospital Hamburg-Eppendorf, Hamburg; Department of Transfusion Medicine, and Department of Gynecology and Obstetrics, Breast Centre, University Hospital Düsseldorf, Düsseldorf; Department of Oncology/Hematology, Klinikum Oldenburg, Oldenburg; Department of Gynecology and Obstetrics, University Hospital Münster, Münster; Department of Oncology/ Hematology, University Hospital Bonn, Bonn; Department of Hematology/ Oncology, Catholic Hospital, Hagen,...
Abstract
Purpose To compare progression-free survival between single and tandem high-dose chemotherapy (HDT) followed by autologous stem-cell transplantation in chemotherapy-sensitive metastatic breast cancer patients. Patients and Methods Between February 1997 and June 2001, 187 patients with complete and partial remission were randomly assigned to receive either one or two cycles of HDT, consisting of thiotepa (125 mg/m2/d for 4 days), cyclophosphamide (1,500 mg/m2/d for 4 days), and carboplatin (200 mg/m2/d for 4 days), followed by autologous stem-cell transplantation. Results One hundred seventy one of 187 randomly assigned patients completed first HDT, but only 52 of 85 completed the second HDT cycle in the tandem HDT arm. The rate of complete remission on an intent-to-treat-basis was 33% in the single-dose HDT arm and 37% in the tandem HDT arm (P = .48). The median progression-free survival times in single and tandem HDT arms were 9.4 and 11.2 months, respectively (one-sided P = .06; two one-sided P = .12), whereas median overall survival time tended to be greater after single versus tandem HDT (29 v 23.5 months, respectively; P = .4). In a multivariate analysis for progression-free survival, tandem HDT (hazard ratio [HR] = 0.71; 95% CI, 0.52 to 0.98; P = .03) and achievement of complete remission after induction chemotherapy (HR = 0.59; 95% CI, 0.37 to 0.96; P = .03) were factors for a better progression-free survival, whereas the factor of three or more sites of metastases (HR = 1.66; 95% CI, 1.12 to 2.47; P = .01) was associated with a worse progression-free survival. Conclusion Despite a trend of improved progression-free survival, tandem HDT cannot be recommended for patients with chemotherapy-sensitive metastatic breast cancer because of a trend for shorter overall survival and higher toxicity compared with single HDT.
Publisher
American Society of Clinical Oncology (ASCO)
Reference25 articles.
1. Survival from first recurrence: relative importance of prognostic factors in 1,015 breast cancer patients.
2. Hortobagyi GN, Frye D, Buzdar AU, et al: Complete remission in metastatic breast cancer: A thirteen year follow-up report. Proc Am Soc Clin Oncol 7: 143,1988, (abstr)
3. High-dose consolidation therapy with autologous stem-cell rescue in stage IV breast cancer: follow-up report.
4. A phase II study of high-dose cyclophosphamide, thiotepa, and carboplatin with autologous marrow support in women with measurable advanced breast cancer responding to standard-dose therapy.
5. Peters WP: Five year follow-up of high-dose combination alkylating agents with ABMT as consolidation after standard-dose CAF for primary breast cancer involving >10 axillary lymph nodes (Duke/CALBGI 8782). Proc Am Soc Clin Oncol 14: 317,1995, (abstr 933)
Cited by
11 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献