High-dose chemo with HSCT outdated for breast cancer

December 14, 2007

NEW YORK (Reuters Health) - No overall survival benefit is gained with high-dose chemotherapy and autologous hematopoietic stem cell transplantation (HSCT) for women with early breast cancer and multiple positive nodes.

The findings of a meta-analysis of 15 large, randomized trials showing the lack of survival benefit were presented by Dr. Donald Berry of The University of Texas M.D. Anderson Cancer Center in Houston at the annual meeting of the San Antonio Breast Cancer Symposium, underway this week.

The trials involved 6,210 women, 3,118 treated with high-dose adjuvant chemotherapy followed by HSCT and 3,092 treated with standard-dose chemotherapy prior to HSCT.

The median follow-up was 6 years, and ranged to 15 years. The median patient age was 46 years, and ranged from 20 to 67 years. Hormone receptor status was positive in 46.8%, negative in 23.7% patients, and unavailable in 29.5%.

After adjusting for age and specifics of the clinical trials, high-dose chemotherapy did not prolong overall survival. It prolonged breast cancer-specific survival "by only a couple of months over the entire 15 years at a very high-cost of terrible adverse effects," Dr. Berry told Reuters Health.

"These women went through hell for more than 1 year, for up to 2 years, with a terrible quality of life, to gain only a couple of months longer survival."

"For breast cancer-specific survival and overall survival, neither age nor hormone receptor status had a statistically significant interaction with treatment, yet there was a significant interaction between age and treatment for disease-free survival," Dr. Berry said in his meeting presentation.

"There was some added progression-free survival of about 8 months with high-dose chemotherapy, but this did not translate into (an overall) survival advantage," he noted.

"We looked for subsets of women who might benefit" from high-dose chemotherapy and HSCT, such as young women, those with multiple positive nodes, those with HER2-positive breast cancer and those with ductal carcinoma. "We found no compelling differences in any of the subsets in terms of survival," Dr. Berry said.

"We are moving away from high-dose chemotherapy and we're trying to tailor treatment to tumor types. We've had a few successes in this area, notably with Herceptin, but long-term success with Herceptin remains to be seen."

"We have to look at the cancer, whether it is node-negative or -positive, if it is HER2-positive, and so on, and look at what we have in our armamentarium...We have to design 'personalized trials,'" the M.D. Anderson oncologist said.

"Stem cells in breast cancer are controversial. What we understand is limited. It appears that we don't have to use transplantation. This does not appear to be the way to go," he concluded.