High-dose chemotherapy with autologous hematopoietic stem-cell transplantation in metastatic breast cancer: overview of six randomized trials

Berry, Donald A, Ueno, Naoto T, Johnson, Marcella M, Lei, Xiudong, Caputo, Jean, Smith, Dori A, Yancey, Linda J, Crump, Michael, Stadtmauer, Edward A, Biron, Pierre, Crown, John P, Schmid, Peter, Lotz, Jean-Pierre, Rosti, Giovanni, Bregni, Marco and Demirer, Taner (2011) High-dose chemotherapy with autologous hematopoietic stem-cell transplantation in metastatic breast cancer: overview of six randomized trials. Journal of Clinical Oncology, 29 (24). pp. 3224-3231. ISSN 1527-7755

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Abstract

PURPOSE
High doses of effective chemotherapy are compelling if they can be delivered safely. Substantial interest in supporting high-dose chemotherapy with bone marrow or autologous hematopoietic stem-cell transplantation in the 1980s and 1990s led to the initiation of randomized trials to evaluate its effect in the treatment of metastatic breast cancer.

METHODS
We identified six randomized trials in metastatic breast cancer that evaluated high doses of chemotherapy with transplant support versus a control regimen without stem-cell support. We assembled a single database containing individual patient information from these trials. The primary analysis of overall survival was a log-rank test comparing high dose versus control. We also used Cox proportional hazards regression, adjusting for known covariates. We addressed potential treatment differences within subsets of patients.

RESULTS
The effect of high-dose chemotherapy on overall survival was not statistically different (median, 2.16 v 2.02 years; P = .08). A statistically significant advantage in progression-free survival (median, 0.91 v 0.69 years) did not translate into survival benefit. Subset analyses found little evidence that there are groups of patients who might benefit from high-dose chemotherapy with hematopoietic support.

CONCLUSION
Overall survival of patients with metastatic breast cancer in the six randomized trials was not significantly improved by high-dose chemotherapy; any benefit from high doses was small. No identifiable subset of patients seems to benefit from high-dose chemotherapy.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Clinical Medicine
Subjects: R Medicine
R Medicine > R Medicine (General)
R Medicine > RC Internal medicine
R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology Including cancer and carcinogens
Depositing User: Tracey O'Gorman
Date Deposited: 01 Nov 2012 15:11
Last Modified: 14 May 2015 09:46
URI: http://sro.sussex.ac.uk/id/eprint/41304
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