Adjuvant dose-intense chemotherapy with peripheral blood stem cell supportin stage II-III breast cancer with five to nine involved axillary lymph nodes

The purpose of this study is to determine outcomes for patients with high-r isk nonmetastatic breast cancer undergoing high-dose chemotherapy with peri pheral blood stem cell support. Forty-three patients with stage IT-III dise ase, five to nine positive axillary lymph nodes, and a median age of 44 yea rs (range, 27-60 years) were enrolled in a study that included: 1) standard dose doxorubicin, 5-fluorouracil, and methotrexate adjuvant therapy; 2) cy clophosphamide, etoposide, filgrastim, and peripheral blood stem cell harve st; and 3) high-dose eye clophosphamide, thiotepa, and carboplatin (CTCb) f ollowed by peripheral blood stem cell infusion. All 43 patients received do xorubicin, 5-fluorouracil, and methotrexate, 42 (98%) received etoposide, a nd 41 (95%) received CTCb. Thirty-two patients (74%) are alive, 28 (65%) wi thout relapse at a median of 55 months (range, 41-87 months). Two died (5%) of treatment-related causes, (subclavian catheter complication after etopo side and late radiation pneumonitis), and nine other deaths (21%) were asso ciated with recurrent breast cancer. The probabilities of overall and event -free survival at 4 years were 0.77 and 0.67, respectively, compared with 0 .82 and 0.69, respectively, for 72 similar patients with 10 or more positiv e axillary nodes receiving the same sequence of therapy. Thus, patients wit h five to nine positive axillary lymph nodes have a similar risk of failure after high-dose chemotherapy and peripheral blood stem cell support as pat ients with 10 or more positive axillary lymph nodes.