High-dose chemotherapy and stem-cell rescue for women with metastatic breast cancer

Metastatic breast cancer is an incurable disease with currently available treatment modalities.  Even though phase III studies have not shown an overall survival advantage from High dose chemotherapy and autologous stem cell transplant (HDC/ASCT) in this group as a whole, it is possible that a small subset of patients may benefit with careful patient selection. We present the results of a multi-institutional phase II study conducted by the North American Transplant Group (NAMTG) which included 198 patients with metastatic breast cancer. In patients who had residual disease at the time of High dose chemotherapy (HDC) and then achieved CR after HDC/ASCT, survival (DFS-19 months, OS-40 months) was similar to patients who had achieved CR with initial standard chemotherapy  (DFS-20.7 months, OS-50.6 months). This study suggests that a subset of patients with residual metastatic breast cancer after standard chemotherapy can achieve complete response with HDC and ASCT, which may result in better long term outcome when compared to patients who continue to have persistent residual disease. This need to be confirmed with further phase III studies and the current consensus regarding this challenging and controversial issue is that the routine practice of high-dose chemotherapy and stem-cell rescue should not be recommended for women with metastatic breast cancer, outside of a clinical trial.

Bibliographic reference:

Kurian S et al.: "Complete Response after High-Dose Chemotherapy and Autologous Hemopoietic Stem Cell Transplatation in Metastatic Breast Cancer Results in Survival Benefit", The Breast Journal 12 (6), 531-535.

Sobha Kurian

West Virginia University, Morgantown, West Virginia, USA