Tandem and triple high-dose chemotherapy with autologous stem cell rescue in metastatic breast cancer

Abstract

The purpose of this phase II study was to evaluate the therapeutic efficacy and toxicity of a tandem or triple high-dose chemotherapy (HDC) with autologous peripheral blood stem cell transplantation (PBSCT) in patients with metastatic breast cancer (MBC) as first line chemotherapy. Conventional chemotherapy consisted of two cycles of epirubicin 120 mg/m2 and ifosfamide 7500 mg/m2 in the case of tandem HDC and one cycle of paclitaxel 135 mg/m2, epirubicin 90 mg/m2 and ifosfamide 6000 mg/m2 in the case of triple HDC. Tandem HDC was composed of two cycles of epirubicin 180 mg/m2, ifosfamide 12000 mg/m2 and carboplatin 900 mg/m2. In the case of triple HDC, paclitaxel 180 mg/m2, etoposide 1500 mg/m2 and thiotepa 600 mg/m2 was added as the third cycle. Patients with tandem HDC (n = 20) were evaluable for both survival and toxicity, and patients with triple HDC (n = 21) only for toxicity because of short-term follow-up. Both tandem and triple HDC were well tolerated and could be safely administered. Non-hematological WHO grade 3 or 4 toxicities were mucositis (8), temporary renal insufficiency (1), myocardial infarction (1), and neuropathy (1). No toxic death occurred. The Kaplan-Meier estimates for 44-months without progression and the overall survival were 12% and 38% respectively. The median survival was 22 months (95% CI: 7.4-51.7 months) and the median progression-free interval 14 months (95% CI: 5.1-43.7 months). In a population with an unfavorable prognosis, tandem HDC showed similar efficacy as to that described in other phase II studies. Triple HDC seems not to improve patient outcome compared to tandem HDC, but a long-term follow up is required.

Stem Cell Dose and Tumorbiologic Parameters as Prognostic Markers for Patients with Metastatic Breast Cancer Undergoing High-Dose Chemotherapy with Autologous Blood Stem Cell Support

“…Another 17 patients received a D‐HDCT regimen with three conventional cycles of doxorubicin and docetaxel followed by one cycle of high‐dose ifosfamide (12,000 mg m –2 ), etoposide (1,500 mg m –2 ), and carboplatin (1,500 mg m –2 ) and one cycle of high‐dose cyclophosphamide (6,000 mg m –2 ) and thiotepa (800 mg m –2 ). For T‐HDCT, one cycle of induction chemotherapy with paclitaxel, ifosfamide and epirubicin was followed by two cycles of stem cell‐supported high‐dose ifosfamide, epirubicin and carboplatin and one cycle of high‐dose paclitaxel (180 mg m –2 ), etoposide (1,500 mg m –2 ), and thiotepa (600 mg m –2 ) [25,, 26]. Seventeen patients were scheduled to receive only one cycle of high‐dose cyclophosphamide (6,000 mg m –2 ), carboplatin (900 mg m –2 ), and thiotepa (500 mg m –2 ) following induction chemotherapy with three cycles of doxorubicin and docetaxel.…”

Renal Complications of High-Dose Chemotherapy and Peripheral Blood Stem Cell Transplantation

“…The stem cells are reinfused the next days after high-dose chemotherapy. Although data regarding nephrotoxicity after PSCT has been presented [5, 6, 7, 8], no previous study has focused on acute renal complications in a cohort entirely treated with PSCT. The purpose of this study was to prospectively evaluate the incidence of ARF and of proteinuria early after PSCT.…”

Quality of Life after Autologous Peripheral Blood Stem Cell Transplantation and High-Dose Chemotherapy in High-Risk Breast Cancer Patients

“…However, there are several studies about bone marrow transplantation but very few about HDCT followed by ASCT [7,8]. Also, data published thus far are limited by short follow-up [9][10][11]. The objectives of this study are: i) to examine the effects of ASCT on QOL; ii) to determine the relationship between long-term QOL and the interval from transplantation; iii) to analyze the correlation between QOL and effect factors (age, tumor characteristics, educational level, marriage, income); iv) to discuss how the QOL of cancer patients may be improved [12][13][14].…”