Lancet 2000; 355: 903 - 910 Download PDF (103
Kb) > >Just a month after doubt was thrown onto the results of a
trial of high-dose chemotherapy for high-risk breast cancer (see
Lancet >2000; 355: 553), the results of a trial in which high-dose
chemotherapy was used in metastatic breast cancer have been published.
In >an early release on the New England Journal of Medicine website (www.nejm.org ), Edward Stadtmauer (University of
Pennsylvania >Cancer Center, Philadelphia, PA, USA) and co-workers report
that "high-dose chemotherapy plus autologous stem-cell
transplantation >soon after the induction of a complete or partial
remission with conventional-dose chemotherapy does not improve survival in
women >with metastatic breast cancer" when compared with standard
maintenance chemotherapy. > >553 women, aged 18-60 years, with
untreated metastatic breast cancer were enrolled in the trial. 58 women had a
complete response to >standard induction chemotherapy; 252 had a partial
response. Of these responders, 110 received high-dose chemotherapy with
stem-cell >rescue and 89 received conventional chemotherapy. There was no
significant difference between treatment groups in 3-year survival
or >median time to progression. However, there was a higher rate of
moderate and severe, but non-fatal, side-effects in the high-dose >group
compared with the standard-dose group. Full quality-of-life data will be
presented later this year, says Stadtmauer. > >Gabriel Hortobagyi
(University of Texas M D Anderson Cancer Center, Houston, TX, USA) describes the
study as "the best and largest >randomised trial so far of high-dose
chemotherapy in metastatic breast cancer". But, he adds, it was underpowered to
detect "modest >differences in relapse-free and overall survival,
especially for patients who received high-dose therapy after achieving a
complete >remission with induction chemotherapy; there may still be an
advantage, but it will be relatively modest". Nevertheless, say
both >Hortobagyi and Stadtmauer, "if that advantage can be achieved with
minimal mortality and morbidity, high-dose therapy might still be >an
important addition to our treatment strategies". > >Jane
Bradbury > >The Association of Cancer Online Resources, a non-profit
501 (c)-3 organization. ACOR, 173 Duane Street, Third Floor, NY, NY
10013 >WWW.ACOR.ORG/
