NEW YORK, Oct 12 (Reuters Health) -- A regimen of high-dose chemotherapy coupled with a transplant of stem cells fails as a treatment for advanced breast cancer in certain groups of women. A study in the October 13th issue of The Journal of the American Medical Association reports that this includes women over age 45, those with hormone-receptor negative tumors, and those who have signs that the cancer has spread to three or more sites.
Because the study showed no benefit from using high-dose chemotherapy, lead study author Dr. Philip Rowlings and his colleagues recommend that these patients "should be treated with the least toxic" chemotherapy regimens.
Advanced breast cancer in which the cancer has spread beyond local lymph nodes or has recurred after treatment is considered an incurable disease, but one possible treatment consists of a regimen of high-dose chemotherapy followed by a transplant of stem cells. High-dose chemotherapy impairs the body's ability to produce blood cells, thus making the transplant of stem cells, which can turn into blood cells, necessary. However, it remains unclear if this treatment increases survival over the traditional regimen of a less toxic, lower dose of chemotherapy.
Rowlings, of the Medical College of Wisconsin in Milwaukee, and colleagues at 63 hospitals in North America, Brazil and Russia, enrolled 1,188 women, aged 18 to 70, with either metastatic or locally recurrent breast cancer in a multi-site study. All these patients received high-dose chemotherapy followed by a stem cell transplant.
In addition to finding that the groups of women listed above failed on the treatment, the study revealed that those with hormone receptor-positive tumors (that is, associated with the hormones estrogen or progesterone) who took the anti-cancer drug tamoxifen after the stem cell transplant fared better.
Rowlings and his co-authors conclude that tamoxifen, recently shown to prevent breast cancer, "should... be recommended for all women with hormone receptor-positive tumors." The authors also suggest that high-dose chemotherapy and stem cell transplant may be beneficial in certain patients who do not fall into one of the groups mentioned above.
In an accompanying editorial, Dr. William Gradishar of the Northwestern University Medical School in Chicago, Illinois, disagrees with that assessment, saying that results from recent studies are conflicting and difficult to interpret. Gradishar concludes that given the available data, high-dose chemotherapy and stem cell transplant "should not be administered outside the context of a clinical trial."
