Journal of Clinical Oncology, Vol 10, 1743-1747, Copyright © 1992 by American Society of Clinical Oncology
High-dose consolidation therapy with autologous stem-cell rescue in stage IV breast cancer: follow-up report
SF Williams, T Gilewski, R Mick and JD Bitran
Department of Medicine, University of Chicago, IL.
PURPOSE: Fifty-nine patients with newly diagnosed metastatic breast cancer
were treated with induction chemotherapy followed by high-dose
intensification and autologous stem-cell rescue (ASCR) to determine
therapeutic efficacy. PATIENTS AND METHODS: Induction consisted of
cyclophosphamide, doxorubicin, vincristine, and methotrexate with
leucovorin rescue (LOMAC) in 27 patients, or fluorouracil, cisplatin,
doxorubicin, and cyclophosphamide (FCAP) in 32 patients. Intensification
after LOMAC was cyclophosphamide and thiotepa (CyTepa) with ASCR, and after
FCAP it was cyclophosphamide, thiotepa, and carmustine (BCNU) in all but
eight patients who received CyTepa. RESULTS: Median survival from study
entry for the entire group was 13.3 months. Median time to progression from
reinfusion for the 45 patients who underwent intensification was 7.5
months. After LOMAC and intensification, there were 12 complete responses
(CR) (nine partial responses [PRs] after induction converted to CRs).
Responses after FCAP and intensification were eight CRs (two PRs after
induction converted to CRs). Median time to treatment failure from
reinfusion was 5.4 months for LOMAC and intensification, and was 10.5
months for FCAP and intensification. Median survival from study entry was
15.1 months for all 27 LOMAC patients and 9.3 months for all 32 FCAP
patients. Median time to treatment failure from reinfusion for 11 patients
who were CRs at intensification has not been reached and is more than 13
months compared with a median of 5.5 months for the 23 patients in partial
remission at intensification. CONCLUSIONS: High-dose intensification
therapy has led to increased CR rates in metastatic breast cancer. The role
of such therapy in the treatment of stage IV breast cancer requires further
refinement.
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