Prognostic and predictive factors for patients with metastatic breast cancer undergoing aggressive induction therapy followed by high-dose chemotherapy with autologous stem-cell support

Purpose: We performed a retrospective review to determine predictive and pr ognostic factors in patients with metastatic breast cancer who received ind uction therapy, and, if they responded to treatment, high-dose chemotherapy , Patients and Methods: Patients with metastatic breast cancer received induc tion therapy with doxorubicin, fluorouracil, and methotrexate (AFM). Partia l responders then received immediate high-dose chemotherapy, whereas those who achieved complete remission were randomized to immediate or delayed hig h-dose chemotherapy with hematopoietic stem-cell support, We performed a re trospective review of data from these patients and used Cox proportional ha zards regression models for analyses. Results: The overall response rate for the 425 patients enrolled was 74% (9 5% confidence interval, 70% to 78%). Multivariate analysis of data from all 425 patients revealed that positive estrogen receptor status (P = .0041), smaller metastatic foci (less than or equal to 2 v > 2 cm) (P = .0165), a l onger disease-free interval from initial diagnosis to diagnosis of metastas es (less than or equal to 2 v > 2 years) (P = .0051 ), and prior treatment with tamoxifen (P = .0152) were good prognostic signs for overall survival. Patients who had received prior adjuvant therapy (P = .0001) and those who developed liver metastases (P = .0001) had decreased rang-term survival. I n the subgroup of responders to AFM induction, multivariate analysis showed that those with visceral metastases did less well (P = .0006), as did pati ents who had received prior adjuvant therapy (P = .0023), However, those wh o had received tamoxifen therapy in the adjuvant setting did better (P = .0 143). Conclusion: The chance for long term remission with induction therapy with AFM and high-dose chemotherapy is increased for hormone receptor positive-p atients with nonvisceral metastases who have not received prior adjuvant ch emotherapy and have long disease-free intervals, (C) 1999 by American Socie ty of Clinical Oncology.