Results of a pilot study of 40 patients using high-dose therapy with hematopoietic rescue after standard-dose adjuvant therapy for high-risk breast cancer

Tomás, J F; Perez-Carrion, R.; Escudero, Antonio; López-Lorenzo, J L; López-Pascual, J.; Fernández-Rañada, J M

doi:10.1038/sj.bmt.1700658

Cited by 22 publications

(16 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These results are significantly better than historical or contemporary data obtained for similar prognosis patients receiving SDC. A number of other phase II trials have also reported encouraging results in high-risk primary disease [61][62][63][64]. ABMTR reported outcomes [43] in high-risk primary disease are consistent with the phase II reports.…”

Section: Hdc For High-risk Primary Breast Cancersupporting

confidence: 81%

High-Dose Chemotherapy and Peripheral Blood Progenitor Cell Transplantation in the Treatment of Breast Cancer

et al. 2000

View full text Add to dashboard Cite

Each year in the USA, 180,000 new cases of breast cancer are diagnosed and about 44,000 women die of the disease. Current primary treatment consists of adjuvant chemotherapy and hormone therapy, and statistics show that combination chemotherapy favorably influences the outcomes in both node-negative and node-positive primary disease. However, a significant number of breast cancer patients succumb to the disease, and nearly every patient diagnosed with metastatic breast cancer will be dead within five years.High-dose chemotherapy (HDC) and peripheral blood progenitor cell transplantation (PBPCT) are based upon laboratory and clinical observations of the ability to modify growth properties of quiescent and replicating cancer cells. A large number of HDC and PBPCT regimens have been evaluated for treatment of metastatic breast cancer, and recent autologous bone marrow transplantation data indicate that three HDC regimens (CPB, CTCb and cytoxan and thiotepa) predominate. Unfortunately, negative media coverage surrounding and subsequent to the presentation of preliminary findings reported at the May 1999 American Society of Clinical Oncologists, that were not allowed adequate follow-up time for full analysis of treatment results, has had a detrimental effect on the ability to conduct trials in this area.Several randomized trials have been conducted in both the metastatic and high risk primary disease settings. Thorough analysis of these studies indicates an evaluable improvement in favor of HDC and PBPCT in three of the four randomized studies performed in metastatic breast cancer and two of the four high risk primary studies. Also, initial evaluations found that quality of life appeared comparable in patients receiving either HDC or not. Each randomized trial studied asks a different question and, depending on the intensity of HDC regimen, the intensity and duration of the standard dose chemotherapy control and the schedule of events in relation to induction chemotherapy, the outcomes may be quite variable. Still, certain general trends are indentifiable. HDC alone will not completely cure breast cancer and should be considered as part of an overall therapeutic plan. In some of these studies, significantly longer follow-up is required before definitive analysis can be completed. The Oncologist 2000;5:1-13

show abstract

Section: Hdc For High-risk Primary Breast Cancersupporting

confidence: 81%

High-Dose Chemotherapy and Peripheral Blood Progenitor Cell Transplantation in the Treatment of Breast Cancer

et al. 2000

View full text Add to dashboard Cite

show abstract

“…The toxicity appears equivalent to previously published reports in women receiving autotransplants for breast cancer. [11][12][13][14] Although the number of subjects is small, the efficacy of autotransplant in these 13 men with high-risk breast cancer appears similar to results reported in women. 11,12 Outcomes of the patients with metastatic disease were disappointing, however only three patients were available for analysis.…”

Section: Discussionsupporting

confidence: 63%

Autotransplants in men with breast cancer

McCarthy

Hurd

Rowlings

et al. 1999

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:The purpose of this study was to determine the outcome of high-dose therapy with autologous hematopoietic stem cell support (autotransplants) in men with breast cancer. We studied 13 men receiving autotransplants for breast cancer and reported to the Autologous Blood and Marrow Transplant Registry (ABMTR) by 10 centers. Six men had stage 2 breast cancer, four had stage 3, and three had metastatic breast cancer. Of twelve tumors tested, all were estrogen receptor positive. Median age at transplant was 50 years. The most common conditioning regimen was cyclophosphamide, thiotepa and carboplatin (n = 5); the remaining eight men received other alkylator-based regimens. Three men received bone marrow, eight received blood stem cells, and two received both for hematopoietic support. All patients had hematopoietic recovery. There were no unexpected regimen-related toxicities. Of 10 men receiving autotransplants as adjuvant therapy, three relapsed 3, 5 and 50 months post-transplant and died 16, 19 and 67 months post-transplant. Seven of 10 are disease-free with median follow-up of 23 months (range 6-50 months). Of three men treated for metastatic breast cancer, one had progressive disease and two recurrent disease at 6, 7 and 16 months post-transplant. In conclusion, results of autotransplants for male breast cancer appear similar to those reported for women receiving autotransplants for breast cancer. Keywords: male breast cancer; autotransplant Male breast cancer accounts for fewer than 1% of all breast cancers. The annual incidence is Ͻ1 per 100 000 males. 1,2 Stage at diagnosis is generally more advanced than in women, possibly as a result of delays in diagnosis. Anatomic factors may also contribute. 3 The median age of men with breast cancer is 5 to 10 years older than women with breast cancer. 1-7 While 64% of premenopausal and 75% of post-menopausal women have estrogen receptor (ER) positive cancers and 58% and 53%, respectively, have progesterone receptor (PR) positive tumors, according to a large study by Clark and colleagues, 8 80-90% of men have ER and PR positive breast cancer. [1][2][3][4][5][6][7] Recent advances in the molecular biology of breast cancer have allowed detection of differences in the BRCA1 and BRCA2 mutations in hereditary and spontaneously occurring female and male breast cancers (reviewed in Refs 9 and 10).The standard therapy of breast cancer in men is similar to treatment in women, including surgery, radiation, hormone therapy and chemotherapy. 1-7 Some investigators report outcomes in men to be the same as in women, when patients are matched for histopathology, receptor state and disease stage. [3][4][5][6] Others suggest that men have poorer outcomes than women despite lower histologic grade, high ER content and small size. 6

show abstract

“…low-up of 36 months the DFS was 84%. Tomás and coworkers 25 recently published their high-dose experience in…”

Section: Treatment Programmentioning

confidence: 99%

High-dose chemotherapy with autologous bone marrow support as consolidation after standard-dose adjuvant therapy in primary breast cancer patients with seven or more involved axillary lymph nodes

Lalisang

Hupperets²,

Haaft³

et al. 1998

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:follow-up data from the CMF Milan experience suggest that even at that time no plateau has been reached. 7 Several studies and retrospective analyses suggest a sigDespite adjuvant chemotherapy the prognosis of patients with breast cancer and a high number of nificant dose-response relationship in metastatic and primary breast cancer. [8][9][10][11] Attempts to further improve these involved axillary lymph nodes is very poor. The aim of the present study was to evaluate the efficacy of highresults by increasing the dose of chemotherapy have met only limited success, mainly due to profound myelodose chemotherapy with autologous bone marrow support in patients with seven or more involved axillary suppression. Autologous bone marrow support (ABMS) offers an opportunity to overcome this problem, but lymph nodes. Nineteen patients underwent four courses of standard adjuvant chemotherapy, followed by highwhether this will lead to better results remains to be determined. dose busulphan/cyclophosphamide chemotherapy with autologous bone marrow support. The median age was High-dose cyclophosphamide has been shown to induce responses in a variety of relapsed or refractory malig-41.4 years and the median number of involved lymph nodes 11. Mucositis WHO grade у3 was observed in nancies and has been part of double alkylator therapy with autologous bone marrow support in advanced breast can-15 patients and 18 patients suffered febrile neutropenia. Transplant-related mortality was encountered in two cer. [12][13][14] Alkylating agents have shown a steep doseresponse relationship in vitro and, when combined, act patients, due to hepatic veno-occlusive disease and sepsis complicated by multi-organ failure, respectively.synergistically to produce response rates higher than those produced by single agents alone. 15,16 After a median follow-up period of 1490 days (range 582-2024 days) from diagnosis, nine patients haveThe preparative regimen busulphan and cyclophosphamide (BuCy) was introduced by Santos and colleagues 17 for relapsed and the overall event-free survival (EFS) is 42% (95% CI 19-65%). The median EFS is 487 days.the treatment of acute non-lymphoblastic leukaemia. This regimen was altered to decrease the toxicity of cyclophosHigh-dose treatment with BuCy2 in high-risk breast cancer patients is a toxic regimen and does not seem to phamide (BuCy2) by Tutschka and coworkers 18 without apparent loss of efficacy. Experience with BuCy2 showed improve disease-free survival. Keywords: adjuvant; bone marrow transplantation; a relatively low treatment-related morbidity, making this bi-alkylator preparative regimen potentially attractive for breast neoplasms drug therapy; busulphan; cyclophosphamide the treatment of solid tumors. 19 In 1991, we started a phase II study to address the question of whether adjuvant chemotherapy followed by highdose consolidation with busulphan and cyclophosphamide Adjuvant chemotherapy has demonstrated a modest, but supported by bone marrow transplantation will improve the consistent improveme...

show abstract

Results of a pilot study of 40 patients using high-dose therapy with hematopoietic rescue after standard-dose adjuvant therapy for high-risk breast cancer

Cited by 22 publications

References 3 publications

High-Dose Chemotherapy and Peripheral Blood Progenitor Cell Transplantation in the Treatment of Breast Cancer

High-Dose Chemotherapy and Peripheral Blood Progenitor Cell Transplantation in the Treatment of Breast Cancer

Autotransplants in men with breast cancer

High-dose chemotherapy with autologous bone marrow support as consolidation after standard-dose adjuvant therapy in primary breast cancer patients with seven or more involved axillary lymph nodes

Contact Info

Product

Resources

About