High-dose chemotherapy with autologous stem cell support for breast cancer: a review of the Dana-Farber Cancer Institute/Beth Israel Hospital experience.

Abstract

The overall median survival of women with advanced or high-risk primary breast cancer has not changed with conventional chemotherapy. Regimens employing high-dose chemotherapy with autologous stem cell support (ABMT) have been developed with the hope of optimizing tumor response and increasing survival. Early phase I studies in women with advanced refractory disease achieved high response rates of short duration. Second generation studies combined an induction phase followed by one high-dose intensification at time of maximum tumor response. The Dana-Farber Cancer Institute/Beth Israel Hospitals have developed the high-dose intensification regimen of cyclophosphamide, thiotepa, and carboplatin (CTCb) for use in women with metastatic and high-risk stage IIIB/inflammatory breast cancer. To date, approximately 19% of women with metastatic disease remain progression free using this approach, with median length of follow-up approaching 40 months. Although the median duration of follow-up for the stage IIIB women is much shorter (approximately 12 months), greater than 90% of these women are thus far disease free. With the advent of hematologic support, such as blood stem cells and colony-stimulating factors, the morbidity, mortality, and costs associated with this treatment have been substantially reduced, allowing for two or more cycles of high-dose intensification to be employed, to exploit the potential of dose-intensity to optimize response.

• Authors: L J Ayash, A Elias, C Wheeler, I Tepler, G Schwartz, L Schnipper, E Frei, K Antman
• Journal: Journal of hematotherapy (J Hematother) Vol. 2 Issue 4 Pg. 507-11 ( 1993) ISSN: 1061-6128 [Print] United States
• PMID: 7916250 (Publication Type: Journal Article, Review)

Chemical References

• Hematopoietic Cell Growth Factors
• Immunologic Factors
• Cyclophosphamide
• Thiotepa
• Carboplatin

Topics

• Adenocarcinoma (drug therapy, mortality, therapy)
• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Blood Transfusion, Autologous
• Bone Marrow Diseases (chemically induced, therapy)
• Boston (epidemiology)
• Breast Neoplasms (drug therapy, mortality, pathology, therapy)
• Carboplatin (administration & dosage, adverse effects)
• Clinical Trials, Phase I as Topic
• Clinical Trials, Phase II as Topic
• Combined Modality Therapy
• Cyclophosphamide (administration & dosage, adverse effects)
• Feasibility Studies
• Female
• Hematopoietic Cell Growth Factors (therapeutic use)
• Hematopoietic Stem Cell Transplantation
• Humans
• Immunologic Factors (therapeutic use)
• Middle Aged
• Neoplasm Staging
• Pilot Projects
• Randomized Controlled Trials as Topic
• Remission Induction
• Retrospective Studies
• Survival Analysis
• Thiotepa (administration & dosage, adverse effects)
• Treatment Outcome