HIGH-DOSE CHEMOTHERAPY, AUTOLOGOUS BONE-MARROW OR STEM-CELL TRANSPLANTATION AND POSTTRANSPLANT CONSOLIDATION CHEMOTHERAPY IN PATIENTS WITH ADVANCED BREAST-CANCER

This study was designed to determine the complete response (CR) rate, event-free survival (EFS) and overall survival (OS) in patients with m etastatic breast cancer treated with an adriamycin-based induction reg imen, high-dose chemotherapy consisting of cyclophosphamide and thiote pa with autologous bone marrow or stem cell reinfusion, followed by po st-transplant 5-fluorouracil and cisplatin, Forty-eight consecutive pa tients were enrolled and 35 received two to four cycles of a cytoreduc tive chemotherapy regimen followed by high-dose chemotherapy which inc luded cyclophosphamide and thiotepa, Thirty-three patients with nonpro gressive disease received at least one cycle of posttransplant 5-fluor ouracil and cisplatin, Fifty percent of patients with evaluable diseas e responded to induction chemotherapy, Three of the 34 patients (9%) e valuable for response to high-dose chemotherapy achieved CR, eight (24 %) achieved partial response (PR), 12 (35%) had stable disease (SD) an d 11 (32%) had progressive disease (PD), The median time to neutrophil recovery was 11.5 days (range, 8 to 40 days) post-reinfusion, The med ian time to platelet independence was 14.5 days (range, 8 to 44 days), The median follow-up is 24.5 months (range, 1 to 96 months). The actu arial probability of EFS for all patients is 17% at 4 years. The EFS f or patients receiving all four cycles of post-transplant chemotherapy is 27% at 4 years, compared to 36% at 1 year for patients not receivin g any post-transplant chemotherapy, Ten of the 48 patients (21%) are a live, and seven of these (15%) have no evidence of disease. High-dose chemotherapy with autologous bone marrow or peripheral blood-derived s tem cell transplantation followed by post-transplant consolidation che motherapy in patients with metastatic breast cancer results in a propo rtion of patients without evidence of disease at 4 years.