High-Dose Chemo Provides Little Benefit to Breast CancerPatients

High-Dose Chemo Provides Little Benefit to Breast CancerPatients
THURSDAY, Dec. 13 (HealthDay News) -- High-dose chemotherapy hasonly a minimal effect on survival in breast cancer patients withnode-positive disease, new research shows.
"It's pretty clearly established that [high-dose chemotherapy] is afalse hope," said study author Donald Berry, head of the Division ofQuantitative Sciences at the University of Texas M.D. Anderson CancerCenter in Houston. "There's a disease-free survival benefit but not muchof a survival benefit. There may be a subset which would benefit, but welooked and couldn't find it."
The study, done in collaboration with the European Blood and MarrowTransplant Group, essentially sounds the death knell for this type oftherapy.
"When you're doing a meta-analysis and combining large numbers ofstudies with different populations, and you're not able to get a reallysignificant survival advantage, I think that the benefits of high-dosechemo are not there," added Dr. Jay Brooks, chairman ofhematology/oncology at Ochsner Health System in Baton Rouge, La. "Outsideof a clinical research trial, I do not recommend high-dosechemotherapy."
The findings are expected to be presented Thursday at the San AntonioBreast Cancer Symposium.
High-dose chemotherapy for breast cancer has a somewhat controversialhistory. The treatment is delivered in conjunction with an autologous(from the same person) bone marrow transplant, which rebuilds bone marrowdamaged by the chemotherapy. The regimen was at one time favored forhigh-risk patients (those whose cancer has spread to at least four lymphnodes).
The rationale for the treatment came from successes in the 1960s and1970s in treating certain leukemia patients with radiation and high-dosechemotherapy, along with bone marrow transplants.
By the late 1980s, the regimen was all the rage. An estimated 20,000 to30,000 U.S. women have undergone high-dose chemotherapy with bone marrowtransplants.
"Ten years ago, if a woman didn't get a bone marrow transplant, peoplewere suing HMOS, because they said they were denying care," Brooks said."The cases won."
Although progressively easier to tolerate, the therapy often causednausea, vomiting, extreme weakness and infection. Some patients even diedfrom the treatment.
Some small studies found that the treatment was beneficial for womenwith very high-risk cancer (at least 10 positive lymph nodes), but thetrials were not randomized.
Later, randomized trials did not confirm the same benefit, and thetreatment has largely fallen out of favor.
"But there were still some nagging questions," Berry said. "One wasthat maybe there was a subset who benefited."
Berry and his colleagues reviewed 15 randomized studies of high-dosechemotherapy conducted around the world between 1988 and 2002. Together,the trials involved more than 6,000 patients with a median follow-up ofseven years.
There was a 13 percent decrease in the rate of breast cancer relapse inpatients receiving high-dose chemotherapy. But that benefit did not extendsurvival. The decrease in mortality was only 6 percent, which was notstatistically significant.
Increasing doses of chemotherapy do have some benefit for breast cancerpatients, but it does reach a point of diminishing returns.
"Increasing the dose is good, but it reaches a plateau," confirmedBerry.
More information
The American Cancer Society has more on chemotherapyfor breast cancer.