High-Dose Therapy with Autologous Bone Marrow Stem Cell Support in Primary and Metastatic Human Breast Cancer

Bergh, Jonas

doi:10.3109/02841869509094046

Cited by 8 publications

(3 citation statements)

References 39 publications

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“…However, high-dose therapy data with marrow support further endorse the concept of a dose-response curve, i.e. patients failing on conventional doses may experience short-lived marked objective responses when given high-dose therapy (206,207). This part of the dose-response concept will be discussed under separate headings below, accordingly the other sections will focus on doses in the 'conventional dose range'.…”

Section: Dose Intensitymentioning

confidence: 93%

“…The use of very high-doses requiring marrow stem cell and:or cytokine support has been investigated in phase II studies indicating the possibility of up to 100% increase in relapse-free survival, from 30% to 60% -70% at ve years (206,207,218). Thirteen international randomised studies are presently testing different facets of high-dose therapy including cytokine-supported therapy with or without bone marrow support (246).…”

Section: High-dose Therapy With Bone Marrow Support :Peripheral Stem mentioning

confidence: 98%

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A Systematic Overview of Chemotherapy Effects in Breast Cancer

Bergh¹,

Jönsson²,

Glimelius³

et al. 2001

Acta Oncologica

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150

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A systematic review of chemotherapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for the evaluation of the scientific literature are described separately (Acta Oncol 2001; 40: 155-65). This synthesis of the literature on chemotherapy for breast cancer is based on 233 randomised studies, 9 meta-analysis of randomised studies, a population-based cohort study and 18 overviews/retrospective analyses including a total of 155,243 patients. The conclusions reached can be summarised into the following points: Adjuvant treatment-- There is solid scientific support from randomised studies that adjuvant polychemotherapy at 10 years will result in an absolute mortality reduction for patients younger than 50 years by 12% for node positive (34% relative mortality reduction corresponding to an estimated median survival prolongation of several years) and 6% for node negative patients. For women aged 50 to 69 years, the corresponding figures for node positive and node negative patients are 6% and 2%, respectively (approximately 11% relative mortality reduction). Anthracycline-containing combinations result in an absolute survival benefit at five years of 3%, compared with non-anthracycline based polychemotherapy. There are indications that the taxane paclitaxel may further improve the survival compared with anthracyclines. However, the limited data preclude conclusions for the routine care. The addition of tamoxifen to chemotherapy further enhances the survival benefit for receptor positive subgroups. The roles of more dose-intensive regimens, including high-dose therapy with stem cell support, are presently studied in randomised investigations. The data presented so far are conflicting but they do not in general support high-dose therapy. Quality of life, based on analyses of randomised studies, demonstrate that adjuvant polychemotherapy has an initial detrimental effect, but long-term follow-up of treated patients demonstrates no impairment of quality of life compared with untreated patients. Polychemotherapy in standard doses should be offered to premenopausal node positive patients, and the corresponding postmenopausal group with a receptor-negative breast cancer and to node negative patients with high risk factors. Polychemotherapy should be combined with tamoxifen to all patients with receptor-positive tumours. Due to a need of more knowledge in this field, patients should be included in investigational protocols. Locally advanced breast cancer-- Based on current knowledge, treatment of patients with locally advanced breast cancer should include neoadjuvant/preoperative polychemotherapy since there is evidence from controlled studies that such therapy will statistically significantly increase the number of patients who can be offered breast-conserving surgery. Indirect comparisons also demonstrate survival improvements, but the scientific support is equivocal. Metastatic breast cancer-- The median survival for patients with metastatic disea...

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Section: Dose Intensitymentioning

confidence: 93%

Section: High-dose Therapy With Bone Marrow Support :Peripheral Stem mentioning

confidence: 98%

A Systematic Overview of Chemotherapy Effects in Breast Cancer

Bergh¹,

Jönsson²,

Glimelius³

et al. 2001

Acta Oncologica

Self Cite

150

View full text Add to dashboard Cite

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“…New routines with skeletal and bone marrow investigations together with CT examinations of other organs will very likely lead to stage migration and thus selection of patients with better prognoses (22). This may thus explain the positive results from uncontrolled high-dose studies in the adjuvant setting (51,52,72,81).…”

Section: Adju6ant High-dose Therapymentioning

confidence: 98%

Is There a Role for Intensive Therapy in Breast Cancer?

Bergh

1999

Acta Oncologica

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With reference to survival, polychemotherapy has been demonstrated to be statistically significantly more effective than monochemotherapy both in the adjuvant setting and in the metastatic situation. Breast cancer demonstrates a dose-response relationship. Chemotherapy used in the conventional dose range should be given with adequate dose-intensity both in the adjuvant setting and for metastatic patients. More dose-intensive combinations are almost always associated with a higher response rate in patients' metastatic disease, but these results have seldom been translated into an improved survival. For marrow requiring high-dose therapy, repeated phase II studies have demonstrated the possibility of a survival tail, which may be due to stage migration and patient selection. At present we have at least 13 ongoing phase III studies in the adjuvant setting and at least 5 ongoing studies in the metastatic situation. These studies will give a definite answer on whether marrow-supported high-dose therapy is better than conventional therapy or if alternative approaches using tailored therapy will result in an equivalent outcome. In the future we must make better use of the present arsenal of drugs and examine the marked inter-individual variations in pharmacokinetic profiles for the drugs. We have to tailor the therapy to the tumour biological profile, in both the primary tumour and metastases with appreciation of heterogeneity and tumour progression. Based on these prerequisites, therapy can be either dose-intensive or in some instances continuous using lower doses.The background, clinical dose-response and dose-intensity data on human breast cancer are reviewed. The article includes discussions of pharmacokinetic considerations and data on the potential of individually tailored chemotherapy aimed at increasing the dose-intensity without simultaneously enhancing the side effects.

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Should All Patients with Inflammatory Breast Cancer Undergo Autologous Stem Cell Transplant?

Overmoyer¹

2000

Current Controversies in Bone Marrow Transplantation

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High-Dose Therapy with Autologous Bone Marrow Stem Cell Support in Primary and Metastatic Human Breast Cancer

Cited by 8 publications

References 39 publications

A Systematic Overview of Chemotherapy Effects in Breast Cancer

A Systematic Overview of Chemotherapy Effects in Breast Cancer

Is There a Role for Intensive Therapy in Breast Cancer?

Should All Patients with Inflammatory Breast Cancer Undergo Autologous Stem Cell Transplant?

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