High-dose chemotherapy with autologous peripheral blood progenitor cell support for primary breast cancer in patients with 4–9 involved axillary lymph nodes

Abstract

Summary:different from that measured in historical controls who received 600 mg/m 2 of BCNU. Combined hospital and physician charges for patients treated at the University Breast cancer patients with more than three involved axillary lymph have a high likelihood of relapse after of Colorado decreased from a mean of $125 845 for the first four patients to $77 126 for the final seven patients. adjuvant therapy. Early results of administration of high-dose chemotherapy (HDCT) and autologous periWe conclude that HDCT with autologous PBPC can be administered with acceptable safety to patients with pripheral blood progenitor cells (PBPC) to patients with primary breast cancer and у у у10 involved axillary nodes mary breast cancer involving 4-9 axillary lymph nodes. An ongoing, prospective randomized trial is evaluating have been encouraging. We performed a multicenter trial to determine whether HDCT could be safely the efficacy of HDCT for this patient group. Keywords: stem cell transplantation; dose-intensive administered to patients with primary breast cancer involving 4-9 axillary lymph nodes. Fifty-four patients therapy; breast cancer with stage II or III breast cancer and 4---9 involved axillary lymph nodes received doxorubicin-based induction chemotherapy, followed by high-dose cyclophosphamideThe prognosis of patients with primary breast cancer is (5.625 g/m 2 ), cisplatin (165 mg/m 2 ), and BCNU directly dependent upon the number of involved axillary (450 mg/m 2 ) and PBPC mobilized by sargramostim lymph nodes at the time of diagnosis. While adjuvant (GM-CSF) or filgrastim (G-CSF). After completion of chemotherapy or hormonal therapy have resulted in benefit HDCT, patients received radiation therapy to the chest for these patients, many still develop recurrent disease.1 wall or involved breast, plus tamoxifen. Survival and High-dose chemotherapy (HDCT) is being employed for disease-free survival, time to engraftment, and charges patients with metastatic breast cancer and for those with associated with HDCT were determined. Plasma conprimary breast cancer who are at great risk of relapse after centrations of BCNU were determined and plasma adjuvant therapy. 2-6 A prospective randomized trial demon-AUC BCNU was calculated. Fifty-four patients were evalustrated that HDCT was superior to standard-dose therapy able for survival and relapse-free survival. Fifty-two for patients with metastatic breast cancer. 7 Treatment for patients received HDCT with PBPC support and were primary breast cancer has been limited to patients with 10 evaluable for toxicity. Fifteen patients (29%) developed or more involved axillary nodes at diagnosis, the early late pulmonary drug toxicity, which resolved with a 10-results of which are extremely promising. 6 Two prospecweek course of corticosteroids in all but one affected tive, randomized trials are ongoing to determine whether patient, who subsequently died of pulmonary toxicity.HDCT is superior to conventional dose therapy for the у10 Ten patients relapsed a median of 426 days (rang...

Enhancement of chemotherapy by manipulation of tumour pH

“…This is significant, because many current clinical studies indicate that threefold accelerated dosing of doxorubicin is more effective in treating node-positive breast cancers (Bearman et al, 1997). However, doxorubicin has associated cardiotoxicity and there is a significant morbidity associated with accelerated dosing regimens.…”

Prognostic importance of the axillary lymph node ratio in autologous transplantation for high-risk stage II/III breast cancer

“…[14][15][16][17][18] Many phase 2 trials have shown the potential therapeutic efficacy of high-dose chemotherapy in autologous PBPC transplantation for high-risk stage II/III breast cancer. [5][6][7][8][9][10] 'High-risk' is generally defined as у10 involved axillary nodes, although data exist showing efficacy of PBPC transplantation in women with 4-9 axillary nodes involved. However, among these many reports, only one describes a multivariate analysis of prognostic factors influencing survival.…”

“…Data from these phase II trials suggested that 60-70% chance of patients with high-risk stage II/III breast cancer might be rendered disease-free with autologous transplantation. [5][6][7][8][9][10] Preliminary results, however, of prospective randomized trials comparing autologous transplantation to less intensive chemotherapy have not shown a significant difference in overall survival at the time of data analysis. 11,12 One trial did show that transplantation was associated with a decreased relapse rate; however, this had not translated into improved survival at the time of data analysis.…”

Prognostic analysis of tumour angiogenesis, determined by microvessel density and expression of vascular endothelial growth factor, in high-risk primary breast cancer patients treated with high-dose chemotherapy

“…We retrospectively analysed tumour samples from patients who were prospectively enrolled in phase II and III trials of HDC for HRPBC at the University of Colorado between 1990 and 2001. A total of 234 patients were accrued in these studies, which were open to patients with 4 -9 positive axillary nodes (n ¼ 102) (Bearman et al, 1997;Moore et al, 2007) and 10 or greater positive nodes (n ¼ 132) (Nieto et al, 2004;Peters et al, 2005). Those trials, as well as the current retrospective review of tumour blocks, were approved by the Cancer Center Protocol Review Committee and the Institutional Review Board.…”