DESIGN OF PREPARATIVE REGIMENS FOR STEM-CELL TRANSPLANTATION IN BREAST-CANCER

We have evaluated tandem cycles of a tri-drug combination, termed CVP (cyclophosphamide, etoposide [VP-16], and cisplatin [Platinol]), at fo ur levels in more than 300 patients with various types of tumors. Tand em CVP appears to be at least therapeutically equivalent to alternativ es. A second potentially non-cross-resistant combination of mitoxantro ne and thiotepa (MT), with or without etoposide, has been used in sequ ence following CVP to improve long-term, disease-free survival in pati ents who have multiple metastatic sites, who relapse shortly after adj uvant therapy, or who show other unfavorable clinical features. A comb ination of MT and etoposide (MVT) achieved an overall response rate of 61% in 32 patients with metastatic or refractory breast cancer. The e toposide was then eliminated to decrease the major toxicities of this regimen. MT was subsequently given to 37 evaluable patients prior to b one marrow infusion. The overall response rate was 48.5%. Thirty patie nts with metastatic breast cancer were then treated with induction the rapy, a cycle of CVP, and then a cycle of MT. Given the low complete r emission (CR) rate to induction therapy in these patients, the CR rate achieved with CVP-MT was encouraging. Further studies are ongoing.