A single scale for comparing dose-intensity of all chemotherapy regimens in breast cancer: summation dose-intensity.

Hryniuk, William M.; Frei, Emil; Wright, Francis

doi:10.1200/jco.1998.16.9.3137

Cited by 102 publications

(62 citation statements)

References 56 publications

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“…The majority of our patient population had early stage disease, but around a third had metastases. The benefit of delivering full RDI to late-stage patients is less clear; it could lead to prolonged life [7], but this must be balanced against toxicity to the patient.…”

Section: Discussionmentioning

confidence: 99%

“…While the relative dose intensity (RDI) achieved may reflect underlying patient factors such as age and co-morbidity, data from studies in the adjuvant setting suggest that failure to receive planned dose contributes to poorer survival [3][4][5]. Ensuring optimal RDI is also a consideration in patients with metastatic disease when the aim of treatment is to prolong life [6,7]. Recent evidence-based guidelines issued by the European Organisation for…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pegfilgrastim primary prophylaxis vs. current practice neutropenia management in elderly breast cancer patients receiving chemotherapy

Aapro¹,

Schwenkglenks²,

Lyman³

et al. 2010

Critical Reviews in Oncology/Hematology

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pegfilgrastim primary prophylaxis vs. current practice neutropenia management in elderly breast cancer patients receiving chemotherapy

Aapro¹,

Schwenkglenks²,

Lyman³

et al. 2010

Critical Reviews in Oncology/Hematology

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“…High-dose chemotherapy with haematopoietic support should be administered early, in a multicycle outpatient programme, and should be epirubicine based. Several questions remain open, such as the eventual role of taxanes in HDC protocols, even if a dose-response effect has not been clearly demonstrated for this family of cytotoxic agents (Hryniuk et al, 1998), and the role of newly available therapies such as anti Her2/neu antibodies. Large clinically relevant and well designed cooperative randomized trials addressing these different issues are still awaited.…”

Section: Discussionmentioning

confidence: 99%

High-dose sequential epirubicin and cyclophosphamide with peripheral blood stem cell support for advanced breast cancer: results of a phase II study

Cottu

Espié

et al. 2001

Br J Cancer

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SummaryThe aim of this study was to evaluate the feasibility of a high-dose intensity and high-dose density multicycle epirubicin and cyclophosphamide regimen with peripheral blood stem cells (PBSC) and haematopoietic growth factor (G-CSF) support in advanced breast cancer patients. From August 1994 to September 1999, 56 breast cancer patients (8 stage IIIB and 48 stage IV) received 205 courses of cyclophosphamide 3 g m -2 and epirubicin 100 mg m -2 every 14 days. G-CSF 5 µg kg -1 day -1 was administered from day 3 to neutrophil recovery. 4 courses were planned. PBSC were collected after course 1, and reinfused after courses 3 and 4, with ≥ 2 × 10 6 CD34+ PBSC kg -1 required for each reinfusion. 48 patients (86%) received all 4 planned courses. Early withdrawal was consecutive to infectious complications (n = 4), severe asthenia (n = 3), haemorrhagic cystitis (n = 1). A median number of 10.8 × 10 6 CD34+ PBSC kg -1 (range, 3-80) was harvested with 1 or 2 apheresis in 48 patients (94%). Median relative dose intensity was 91.3% (range, 72-102%). Grade 4 neutrophil toxicity was observed in 100% of patients. Febrile neutropenia was observed in 40% of courses (median duration 2 days). Red blood cells and platelets had to be transfused in 54% and 27% of courses, respectively. There were no toxic deaths. Objective response rate was 69% in stage IV patients (31/45 evaluable pts), with a 16% complete response rate. Their median progression-free and overall survivals were 22.5 and 37 months, respectively. This epirubicine-containing high-dose regimen appeared feasible, albeit with high toxicity. Time-related progression parameters exceed commonly reported ones. Controlled studies of upfront sequential high-dose chemotherapy are still needed to evaluate its real benefit.

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“…Extensive literature reviews by Hryniuk et al 1,2 have found dose intensity to be correlated with response rate and survival. This effect has been considered in the rationale of many clinical trials that attempted to improve long-term survival in metastatic BC by delivering single courses of high-dose chemotherapy (HDC).…”

mentioning

confidence: 99%

Multiple cycles of dose-intensive chemotherapy with repeated stem cell support as induction treatment in metastatic breast cancer: a feasibility study

García-Rayo

Pérez‐Calvo

Martín‐Algarra

et al. 2001

Bone Marrow Transplant

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Summary:The purpose of this trial was to study feasibility and tolerance of a dose-intensive multicyclic alternating induction chemotherapy with repeated stem cell support in a series of 43 metastatic breast cancer patients. ades. Extensive literature reviews by Hryniuk et al 1,2 have found dose intensity to be correlated with response rate and survival. This effect has been considered in the rationale of many clinical trials that attempted to improve long-term survival in metastatic BC by delivering single courses of high-dose chemotherapy (HDC). Despite some promising data derived from phase II trials, results of the randomized studies published thus far have failed to show a sound clinical benefit for single autografts. [3][4][5] There might be other ways to take advantage of the doseintensity principle. In vitro, repeated doses of chemotherapy cause more cell kill than single doses, even though the total amount of drug administered is the same. 6 The classical model of Gompertzian kinetics provides a possible explanation for this fact through rapid compensatory re-growth of the resistant clones not eradicated by HDC. 7 The spread of the cytotoxic effect over a longer period of time might increase cell kill and reduce the probability of drug resistance. 8 Multicyclic treatment schemes appear to take advantage of the inherent time-dependant responsiveness of most cancer tissues.Autologous peripheral blood stem cell infusions have been extensively used to support single courses of HDC. Nonetheless, their possible use in programs of multicyclic non-myeloablative dose-intense chemotherapy has been little explored. [9][10][11][12] In November 1995, the Department of Oncology of University of Navarra, Spain, initiated a feasibility study that included a biweekly, alternating, doseintensive chemotherapy regimen. The results observed in the first 43 patients with metastatic BC are presented in this report. Materials and methodsWomen with histologically proven metastatic BC were evaluated for study entry. An ECOG performance status of 0-1, age less than 65 years, and no evidence of cardiac, pulmonary, liver or renal impairment were required. All patients gave written informed consent according to institutional policy before entering the study. Patients presenting with brain metastases, leptomeningeal disease, or bone marrow involvement, as well as patients previously

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A single scale for comparing dose-intensity of all chemotherapy regimens in breast cancer: summation dose-intensity.

Cited by 102 publications

References 56 publications

Pegfilgrastim primary prophylaxis vs. current practice neutropenia management in elderly breast cancer patients receiving chemotherapy

Pegfilgrastim primary prophylaxis vs. current practice neutropenia management in elderly breast cancer patients receiving chemotherapy

High-dose sequential epirubicin and cyclophosphamide with peripheral blood stem cell support for advanced breast cancer: results of a phase II study

Multiple cycles of dose-intensive chemotherapy with repeated stem cell support as induction treatment in metastatic breast cancer: a feasibility study

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