HIGH-DOSE CHEMOTHERAPY AND AUTOLOGOUS STE M-CELL SUPPORT FOR THE TREATMENT OF SOLID TUMORS IN ADULTS .1.

Autologous bone marrow transplantation for the treatment of solid tumo rs in adults remains an uncommon therapeutic approach. The feasibility of such hight-dose therapies is clearly proved, especially with the a dvent of hematopoietic growth factors and the rescue by the peripheral stem cells to reduce the duration of the chemotherapy-induced myeloid aplasia. The question is to exactly define the place of high-dose the rapy in the land of solid tumors. For the treatment of primary chemore sistant gonadal germ-cell tumors, the possibility to cure the patients and the interest of high-dose therapy with autologous bone marrow tra nsplantation are clearly demonstrated. As consolidation for the treatm ent of poor prognosis tumors, the place of high-dose therapies remains moot. For the treatment of chemoresistant extragonadal germ-cell tumo rs, especially for primary mediastinal tumors, the level of resistance to cisplatin-based chemotherapy regimens is generally too high to be overcome by intensive therapies given as single course or as tandem co urses. However in association with debulking surgery, this therapeutic approach has to be considered for some patients. In the treatment of poor prognosis breast cancer, high-dose therapy with autologous bone m arrow transplantation or with peripheral stem cells support is able to converte some patients with partial response into complete responders . However, the consequences on overall survival and on disease-free su rvival are not evident. For metastatic breast cancer and for poor-prog nosis tumors (inflammatory breast cancer, axillary metastatic nodes gr eater-than-or-equal-to 8), the interest of high-dose therapy has to be determined by randomized studies. These studies are ongoing in USA an d in Europe. For the treatment of poor-prognosis ovarian cancer, the s ituation is more difficult to appraise. Once again, randomized studies have to be done to precisely define the place of high-dose therapy. I n the land of small-cell lung carcinomas, high-dose therapy is actuall y forsaken by most of authors, even for limited diseases. The results of previous studies are disappointing. Moreover, occult medullary micr ometastases involvement is frequent, once again even in limited diseas es. However new therapeutic associations, as the ICE regimen (IFM, Car boplatin, VP-16) delivered as single or tandem therapy, have to be stu died, especially as early consolidation therapy for the treatment of l imited small-cell lung carcinomas.