High-dose chemotherapy and autologous bone marrow or stem cell transplantation versus conventional chemotherapy for women with metastatic breast cancer
- 20 July 2005
- journal article
- research article
- Published by Wiley in Cochrane Database of Systematic Reviews
- Vol. 2021 (5), CD003142
- https://doi.org/10.1002/14651858.cd003142.pub2
Abstract
Background Although metastatic breast cancer is often responsive to conventional chemotherapy, it remains ultimately incurable. Autologous transplantation of bone marrow or peripheral stem cells (in which the patient is both donor and recipient) has been considered a promising technique because it allows much higher doses of chemotherapy to be used. Objectives To compare the effectiveness of high dose chemotherapy and autologous bone marrow or stem cell transplantation (autograft) with conventional chemotherapy for women with metastatic breast cancer. Outcomes were survival rates, treatment‐related toxicity and quality of life. Search methods We used the Cochrane Breast Cancer Group search strategy, adding these terms: bone marrow transplantation, stem cell transplantation, autologous stem cell support. The following databases were searched up to August 2010: MEDLINE, EMBASE, The Cochrane Library and ASCO (American Society of Clinical Oncology). We also searched the Cochrane Breast Cancer Group database and trial registries for unpublished trials, and checked the reference lists of articles found. Selection criteria Randomised controlled trials comparing the effectiveness of high dose chemotherapy and autograft with conventional chemotherapy for women with metastatic breast cancer. Data collection and analysis Six randomised controlled trials met the inclusion criteria. Two independent reviewers extracted data. Main results In total 437 eligible women were randomised to receive high dose chemotherapy with autograft and 413 were randomised to receive conventional treatment. There were fifteen treatment‐related deaths among the high dose group and two in the control (conventional dose) group (RR 4.08, 95% CI 1.40 to 11.93). There was no statistically significant difference in overall survival between the high dose and control groups at three years or five years. At five years of follow up, there was a statistically significant difference in event‐free survival, favouring the high dose group (RR 2.84, 95% CI 1.07 to 7.50). Toxicity was more severe in the high dose group. Only one of the trials has followed up all women for five years. Authors' conclusions Although there is evidence that high dose chemotherapy and autograft significantly improves event‐free survival compared to conventional chemotherapy in women with metastatic breast cancer there is no significant evidence of benefit in overall survival. High dose chemotherapy with bone marrow or stem cell transplantation should not be given to women with metastatic breast cancer outside of clinical trials.Keywords
This publication has 24 references indexed in Scilit:
- Randomized Trial of High-Dose Chemotherapy With Autologous Peripheral-Blood Stem-Cell Support Compared With Standard-Dose Chemotherapy in Women With Metastatic Breast Cancer: NCIC MA.16Journal of Clinical Oncology, 2008
- Pegase 03: a prospective randomized phase III trial of FEC with or without high-dose thiotepa, cyclophosphamide and autologous stem cell transplantation in first-line treatment of metastatic breast cancerBone Marrow Transplantation, 2007
- Consolidation with High-Dose Combination Alkylating Agents with Bone Marrow Transplantation Significantly Improves Disease-Free Survival in Hormone-Insensitive Metastatic Breast Cancer in Complete Remission Compared with Intensive Standard-Dose Chemotherapy AloneTransplantation and Cellular Therapy, 2006
- High-dose chemotherapy with haematopoietic stem cell transplantation for metastatic breast cancer patients: final results of the French multicentric randomised CMA/PEGASE 04 protocolEuropean Journal Of Cancer, 2005
- Up-Front Tandem High-Dose Chemotherapy Compared With Standard Chemotherapy With Doxorubicin and Paclitaxel in Metastatic Breast Cancer: Results of a Randomized TrialJournal of Clinical Oncology, 2005
- 440 Superiority of tandem high-dose (HDC) over conventionally-dosed chemotherapy(CDC) in patients (Pts) with metastatic breast cancer (MBC): Updated results of the international randomised breast cancer dose-intensity study (IBDIS)European Journal of Cancer Supplements, 2003
- A randomized trial of high-dose chemotherapy (HDCT) with autologous peripheral blood stem cell support (asct) compared to standard chemo therapy (ct) in women with metastatic breast cancer: a National Cancer Institute of Canada (NCIC) clinical trials group studyEuropean Journal Of Cancer, 2001
- Status of high-dose chemotherapy for breast cancer: A reviewTransplantation and Cellular Therapy, 2000
- Systematic reviews of chemotherapy and endocrine therapy in metastatic breast cancerCancer Treatment Reviews, 2000
- Conventional-Dose Chemotherapy Compared with High-Dose Chemotherapy plus Autologous Hematopoietic Stem-Cell Transplantation for Metastatic Breast CancerNew England Journal of Medicine, 2000