A. Schneeweiss et al., Comparison of double and triple high-dose chemotherapy with autologous blood stem cell transplantation in patients with metastatic breast cancer, STEM CELLS, 19(2), 2001, pp. 151-160
In patients with metastatic breast cancer (MBC), early dose intensification
,vith multiple cycles of peripheral blood stem cell supported high-dose che
motherapy (HDCT) seems superior to a late dose-intensification strategy. We
compared the progression-free survival (PFS) and overall survival (OS) of
20 patients treated with a double (D)-HDCT regimen to 20 patients who recei
ved a triple (T)-HDCT, matched by age, estrogen receptor (ER) status, adjuv
ant chemotherapy, initial disease-free interval, predominant metastatic sit
e, and number of metastatic sites. At a median follow-up of 41.5 months (ra
nge, 14-88 months) an intent-to-treat analysis showed no difference in PFS
(p = 0.72) and OS (p = 0.93) between the matched patients. For all 76 patie
nts treated within the D- or T-HDCT trial, median PFS and OS was 13 months
(range, 2-78 months) and 24.5 months (range, 7-78 months), respectively. In
multivariate analysis independent predictors of shorter OS included negati
ve ER (relative risk [RR] = 3.0 [95% confidence interval (Cr) 1.5-5.9]; p =
0.002), more than two metastatic sites (RR = 2.4 [95% CI 1.0-5.7]; p = 0.0
49) and failure to achieve complete remission/no evidence of disease (CR/NE
D) after HDCT (RR = 4.5 [95% CI 2.0-10.1]; p < 0.0001). These data show tha
t early dose intensification with T-HDCT is not superior to a D-HDCT regime
n in patients with MBC. ER-negative tumors, more than two metastatic sites
and no CR/NED after HDCT, are associated with inferior outcome.