Cancer Research Lab

High-dose chemotherapy with autologous stem-cell transplantation does not improve overall survival when used as consolidation therapy after response to induction therapy in women with metastatic breast cancer, Canadian researchers report.

One small controlled trial has suggested there are improvements in overall survival after two courses of high-dose chemotherapy supported by autologous stem-cell transplantation, compared with standard-dose chemotherapy, the authors explain in the January 1st issue of the Journal of Clinical Oncology.

Dr. Michael Crump at Princess Margaret Hospital in Toronto and colleagues investigated whether the addition of one course of high-dose chemotherapy and autologous stem-cell transplantation could improve overall survival among women with metastatic breast cancer who responded to optimal chemotherapy. They also evaluated the effects of this treatment on quality of life.

Similar proportions of women in the two groups experienced complete and partial responses, the authors report.

Median overall survival was 24 months for patients receiving high-dose chemotherapy, compared with 28 months for patients receiving standard-dose chemotherapy.

Overall survival also did not differ among those who had complete responses or no evidence of disease after induction therapy, for those without visceral disease, or by type of induction therapy.

Median progression-free survival was significantly longer for women who had high-dose chemotherapy (11 months) than for those who had standard-dose chemotherapy (9 months), the researchers report.

Grade 3 and 4 toxicity was also significantly more common after high-dose chemotherapy, the investigators note.

At the first follow-up, women who had high-dose chemotherapy reported significantly worse physical function, role function, social function, fatigue, dyspnea, and global quality of life.

At the 6-month and 9-month follow-ups, these women also reported worse dyspnea, bruising, and bleeding than women who had standard-dose chemotherapy.

“We could not identify any subgroup that derived greater benefit with high-dose chemotherapy than with standard-dose chemotherapy.”

“On the basis of our results,” the investigators conclude that there is “no role for high-dose chemotherapy requiring autologous hematopoietic stem cell transplantation in women with metastatic breast cancer outside of a well-designed, scientifically meritorious clinical trial.”