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High-Dose Chemotherapy and Breast Cancer

Hortobagyi et al. (p. 225) have conducted a prospective randomized trial involving women with high-risk (of relapse) breast cancer to compare the outcomes of patients treated with standard-dose chemotherapy and patients treated with the same therapy followed by high-dose chemotherapy. Seventy-eight women received eight cycles of 5-fluorouracil, doxorubicin, and cyclophosphamide. They were then randomly assigned to receive no further treatment or to receive two cycles of high-dose cyclophosphamide, etoposide, and cisplatin with autologous hematopoietic stem cell support (bone marrow transplantation). The authors report no relapse-free or overall survival advantage associated with the use of high-dose chemotherapy and note that morbidity was increased with this therapeutic approach. They conclude that, at present, high-dose chemotherapy for high-risk breast cancer is not indicated outside a clinical trial.

“Although this was a small trial designed to detect a 30% difference in 3-year relapse-free survival, it accomplished its goal and ruled out a large reduction in risk associated with high-dose chemotherapy.”