TY - JOUR
T1 - Complete response after high-dose chemotherapy and autologous hemopoietic stem cell transplatation in metastatic breast cancer results in survival benefit
AU - Kurian, Sobha
AU - Qazilbash, Muzzafar
AU - Fay, Joseph
AU - Wolff, S.
AU - Herzig, Roger
AU - Hobbs, Gerry
AU - Bunner, Pam
AU - Weisenborn, Robin
AU - Aya-ay, Melanie
AU - Lynch, Joseph
AU - Ericson, Solveig
PY - 2006/11
Y1 - 2006/11
N2 - Metastatic breast cancer is an incurable disease even with high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (ASCT). Even though phase III studies have not shown a survival advantage for this group as a whole, it is possible that a small subset of patients may benefit from HDC/ASCT with careful patient selection. A total of 198 patients from three different institutions were treated with HDC/ASCT. After complete staging, patients with central nervous system or bone marrow involvement were excluded. The HDC regimen consisted of: Carboplatin 600 mg/m 2 IV infusion over 48 hours, Thiotepa 300 mg/m 2 IV infusion over 2 hours, and Cytoxan 60 mg/kg IV infusion given over 2 hours ×3 days. The median age at the time of transplant was 46 (24-62) years and median follow-up was 20 months. Hormone receptor status was known in 148 patients, of whom 84 had estrogen receptor (ER) and/or progestrone receptor (PgR)-positive tumors. Eighty patients had no evidence of disease at the time of HDC/ASCT (CR1). At the completion of HDC and ASCT, complete responses (CR) were seen in an additional 57 patients (CR2). Using Kaplan-Meier analysis, the median relapse-free survival (RFS) for the entire group was 15 months and overall survival (OS) was 27 months. The patients in CR1 had a median RFS and OS of 20.7 and 50.6 months, respectively. This was very similar to the RFS and OS in patients achieving CR2 after HDC/ASCT (p < 0.001; median: 19 and 40 months, respectively). In contrast, the patients with persistent residual disease had an RFS and OS of 7 and 12 months (p < 0.001). These data show that patients achieving a CR after HDC/ASCT have a better relapse-free and OS, when compared to patients with persistent residual disease after HDC/ASCT. This study suggests that a subset of patients with residual metastatic breast cancer after standard chemotherapy can achieve CR with HDC and ASCT which may result in better long-term outcome.
AB - Metastatic breast cancer is an incurable disease even with high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (ASCT). Even though phase III studies have not shown a survival advantage for this group as a whole, it is possible that a small subset of patients may benefit from HDC/ASCT with careful patient selection. A total of 198 patients from three different institutions were treated with HDC/ASCT. After complete staging, patients with central nervous system or bone marrow involvement were excluded. The HDC regimen consisted of: Carboplatin 600 mg/m 2 IV infusion over 48 hours, Thiotepa 300 mg/m 2 IV infusion over 2 hours, and Cytoxan 60 mg/kg IV infusion given over 2 hours ×3 days. The median age at the time of transplant was 46 (24-62) years and median follow-up was 20 months. Hormone receptor status was known in 148 patients, of whom 84 had estrogen receptor (ER) and/or progestrone receptor (PgR)-positive tumors. Eighty patients had no evidence of disease at the time of HDC/ASCT (CR1). At the completion of HDC and ASCT, complete responses (CR) were seen in an additional 57 patients (CR2). Using Kaplan-Meier analysis, the median relapse-free survival (RFS) for the entire group was 15 months and overall survival (OS) was 27 months. The patients in CR1 had a median RFS and OS of 20.7 and 50.6 months, respectively. This was very similar to the RFS and OS in patients achieving CR2 after HDC/ASCT (p < 0.001; median: 19 and 40 months, respectively). In contrast, the patients with persistent residual disease had an RFS and OS of 7 and 12 months (p < 0.001). These data show that patients achieving a CR after HDC/ASCT have a better relapse-free and OS, when compared to patients with persistent residual disease after HDC/ASCT. This study suggests that a subset of patients with residual metastatic breast cancer after standard chemotherapy can achieve CR with HDC and ASCT which may result in better long-term outcome.
KW - Autologous transplant
KW - Breast cancer
KW - High-dose chemotherapy
UR - http://www.scopus.com/inward/record.url?scp=33750625208&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33750625208&partnerID=8YFLogxK
U2 - 10.1111/j.1524-4741.2006.00341.x
DO - 10.1111/j.1524-4741.2006.00341.x
M3 - Article
C2 - 17238982
AN - SCOPUS:33750625208
SN - 1075-122X
VL - 12
SP - 531
EP - 535
JO - Breast Journal
JF - Breast Journal
IS - 6
ER -