MILWAUKEE, Oct. 15 (AScribe) -- A major international study of patients with advanced breast cancer identified several groups unlikely to benefit from high dose chemotherapy followed by infusion of their own stem cells or autotransplantation.
The study of 1,188 patients at 63 hospitals in North America, Brazil and Russia was published in the October 13, 1999, issue of JAMA.
It concludes that these women should receive the treatment only after being informed of its likely outcome and in the context of clinical trials attempting to improve outcome.
"Identifying women most likely to benefit or very unlikely to benefit from autotransplantation for advanced breast cancer is important for patients, for physicians, considering treatment options and for investigators developing new trials," says Mary Horowitz, M.D., M.S., professor of medicine at the Medical College, and scientific director of the International Bone Marrow Transplant Registry and the Autologous Blood and Marrow Transplant Registry, both headquartered at the Medical College.
"Factors predicting treatment failure after conventional therapy for advanced breast cancer have been well-established, but few comprehensive studies of such factors for women receiving autotransplants have been published," she adds.
The researchers found several factors linked to greater risk of treatment failure, and that women with three or more of these factors had only a four percent probability of disease-free survival after three years. For those with none of the negative risk factors, however, the probability of three-year, disease-free survival rose to 43 percent.
The factors linked to failure of autotransplantation include: - Age: over 45 years old - Less than good physical condition otherwise - Absence of hormone receptors on tumor cells - Prior use of adjuvant chemotherapy - Initial disease-free survival interval of 18 months or less after adjuvant chemotherapy - Metastases in the liver or central nervous system, versus. soft tissue, bone or lung - Three or more sites of metastatic disease - Incomplete response, versus complete response, to standard dose chemotherapy.
The study also revealed that women with hormone receptor-positive tumors could reduce their risk of treatment failure by taking tamoxifen after autotransplantation. The researchers analyzed data from the Autologous Blood and Marrow Transplant Registry which collects outcomes information on about half of the autotransplants done for breast cancer in North America. Hematologist/oncologist Philip Rowlings, M.B.B.S., who was a visiting professor of medicine at the Medical College and is now head of the BMT program at Prince of Wales Hospital in Sydney, Australia, led the team.
