HIGH-DOSE CHEMOTHERAPY WITH AUTOLOGOUS STEM-CELL RESCUE FOR BREAST-CANCER - YESTERDAY, TODAY AND TOMORROW

Metastatic breast cancer remains incurable by conventional means and i s the second leading cause of all cancer deaths in women in the United States, Laboratory and clinical studies have shown chemotherapy dose intensity may be important in breast cancer therapy, and therefore cli nical trials have been investigating high-dose chemotherapy (HDC) with autologous stem cell rescue (ASCR) for the past decade, Initial Phase I trials in heavily pretreated patients demonstrated good response ra tes but short survival times. The next generation of trials used HDC a s initial treatment for metastatic breast cancer and showed improved r esults, Most recently, patients receive HDC after ''induction'' chemot herapy to minimize tumor burden prior to HDC. Results from these most recent trials are encouraging, with complete remissions (CR) achievabl e in at least half of patients and long-term survivors noted, An ongoi ng randomized trial of HDC versus conventional chemotherapy should ans wer whether HDC is superior to conventional chemotherapy for metastati c breast cancer. Based on encouraging data from a preliminary trial, t wo ongoing randomized trials are comparing HDC versus conventional che motherapy in high-risk primary breast cancer. Technological improvemen ts, better supportive care and experience have all contributed to decr ease the morbidity and mortality of this procedure. Additionally, hosp italizations have become shorter and costs may be decreasing. This rev iew will discuss the issues pertinent to this modality in the past and present, including chemotherapy regimens, stem cell technology and re lated issues, outcomes, ongoing trials and future directions for consi deration.