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The CancerWeb Report, What's New In Cancer
Breast Cancer: October 1995
Last modified on:
Tuesday, April 20, 1999 12:03:10
Copyright © 1994-2008, Information Ventures, Inc.
High-dose chemotherapy - The use of high-dose chemotherapy for treatment of metastatic
breast cancer is controversial, with high response rates reported
in a number of small non-randomized studies that have been
criticized by other investigators as being subject to patient
selection bias. No randomized trials have looked at the question
until now. A report by Bezwoda et al. from the University of
Witwatersrand in South Africa, published in the October, 1995 issue of
the Journal of Clinical Oncology, describes the first randomized
trial of high dose chemotherapy in 45 patients with this disease.
Two cycles of high-dose chemotherapy (HD-CNV; cyclophosphamide,
2.4 g/m2, mitoxantrone, 35-45 mg/m2, and etoposide, 2.5 g/m2),
were compared to 6-8 cycles of conventional dose chemotherapy
(CNV; cyclophosphamide, 600 mg/m2, mitoxantrone, 12 mg/m2, and
vincristine, 1.4 mg/m2) as first line treatment. HD-CNV included
either autologous bone marrow or peripheral-blood stem-cell
rescue. Overall response rate was 95%, with 51% complete
remissions for HD-CNV versus 53% overall survival and 4% complete
remissions for CNV. Median durations of survival were 90 and 45
weeks for HD-CNV and CNV, respectively. Toxicity was moderate in
most patients, but all had mucositis and hematologic suppression
requiring supportive treatment. Hair loss was also universal for
HD-CNV compared with about 40% with CNV, and about two-thirds had
episodes of fever. Clinical cardiotoxicity occurred in three
patients in each group. While only a small study, this first
randomized trial does point out the efficacy of the high-dose
approach, while indicating that specifics of optimal dose and
schedule need to be addressed.
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