Cancer Treatment Today

High-dose chemotherapy in breast cancer continues to be a controversial subject. Following an era in which this treatment modality was considered by many to represent a standard of care for patients with high-risk primary breast cancer, many physicians and most of the public now believe that high-dose chemotherapy is both excessively toxic and ineffective. This precipitous shift of opinion has been caused by the publication of a small number of randomized studies that did not show benefit for the high-dose approach. In addition, a scientific misconduct investigation has revealed that the author of the only two randomized studies of high-dose therapy that showed a significant benefit falsified data. The history and analysis of this cause celebre can be found at http://www.cancer.gov/clinicaltrials/digestpage/high-dose-chemo.

After this fiasco, research in HDSCT in breast cancer slowly recovered. Itremains a legitimate area of investigation but is not in routine clinical use and remains investigational.

In 2010, it was reported tha tautologous stem cell transplantation can more frequently give rise to severe complications affecting almost all organ systems. Compared to conventional chemotherapy, autologous stem cell transplantation can extend “event-free survival” for breast cancer patients.This is the conclusion of the final report of the Institute for Quality and Efficiency in Health Care (IQWiG) published on 16 December 2009.

However, a 2011 review(Berry et al) concluded: “Overall survival of patients with metastatic breast cancer in the six randomized trials was not significantly improved by high-dose chemotherapy; any benefit from high doses was small. No identifiable subset of patients seems to benefit from high-dose chemotherapy.

S. Rodenhuis The Status of High-Dose Chemotherapy in Breast Cancer The Oncologist, Vol. 5, No. 5, 369-375, October 2000

Donald A. Berry, High-Dose Chemotherapy With Autologous Hematopoietic Stem-Cell Transplantation in Metastatic Breast Cancer: Overview of Six Randomized Trials JCO July 18, 2011

A.R. Zander, N. Kroger, C. Schmoor, W. Kruger, V. Mobus, N. Frickhofen, B. Metzner, W. Schultze, W.E. Berdel, M. Koenigsmann, et al.
High-Dose Chemotherapy With Autologous Hematopoietic Stem-Cell Support Compared With Standard-Dose Chemotherapy in Breast Cancer Patients With 10 or More Positive Lymph Nodes: First Results of a Randomized Trial
J. Clin. Oncol., June 15, 2004; 22(12): 2273 – 2283.

S. Rodenhuis, M. Bontenbal, L. V.A.M. Beex, J. Wagstaff, D. J. Richel, M. A. Nooij, E. E. Voest, P. Hupperets, H. van Tinteren, H. L. Peterse, et al.
High-Dose Chemotherapy with Hematopoietic Stem-Cell Rescue for High-Risk Breast Cancer
N. Engl. J. Med., July 3, 2003; 349(1): 7 – 16.

NCCN.ORG, Breast Cancer

Revised 9/21/2011