Patients with metastatic
breast cancer in complete remission are the ones most likely to have an improved outcome with subsequent high-dose
chemotherapy and autologous
peripheral blood stem cell transplantation (HDC-PBSCT). Peripheral blood stem cells are usually procured following mobilization with single agent
chemotherapy and
colony-stimulating factor support. We utilized a dose-intense regimen of
paclitaxel 200 mg/m2 i.v.,
etoposide 60 mg/kg i.v., and
cyclophosphamide 3 g/m2 i.v. (TEC) followed by daily administration of
granulocyte colony-stimulating factor. The aim was not only to mobilize stem cells but also to achieve optimal
tumor cytoreduction prior to HDC/PBSCT. One hundred consecutive patients with metastatic
breast cancer received 257 cycles of TEC between March 1994 and June 1997, with the aim of collecting 5 x 106 CD34-positive cells/kg usually following the second cycle of
chemotherapy. Patient characteristics included a median age of 45 years, a median of two organ systems involved by disease, a median of two prior
chemotherapy regimens and eight prior
chemotherapy cycles, and a median interval of 8 months from diagnosis of
metastases to first cycle of TEC. There were 61 febrile episodes during
neutropenia and 13 of these were associated with
bacteremia or
fungemia. Mortality rate was 1%. An adequate number of stem cells was collected in 90% of patients. The overall response rate of the
tumor was 58.8% with 23.7% complete responders among 97 evaluable patients. Multivariate analysis demonstrated chemosensitivity to the most recent standard
chemotherapy regimen administered for metastatic disease, an ECOG performance score of 0 as opposed to 1, 2 or 3, and involvement by disease of only one organ system as significant variables for achieving a complete remission with TEC. This novel dose-intense regimen was safe and well tolerated, highly active against metastatic
breast cancer, and capable of excellent
stem cell mobilization.
Bone Marrow Transplantation (2000) 25, 123-130.