Two Cycles of High Dose Chemotherapy with Autologous Bone Marrow Support for Patients with Locally Advanced Breast Cancer

Abstract

: Purpose: To examine the impact of two cycles of high dose chemotherapy (HDC) with autologous bone marrow rescue (ABMR) in the treatment of women with locally advanced breast cancer. Patients and Methods: Twenty-three patients not exhibiting progressive disease to conventional dose therapy (ltx) were eligible for HDC. Conventional dose regimens used were the CAMFTP regimen (n= 6), 5-FU, doxorubicin and cyclophosphamide (n= 3), cyclophosphamide, methotrexate and 5-FU (n= 1), or doxorubicin/cyclophosphamide (n= 13). HDC on each cycle consisted of etoposide 625 mg/m2, cyclophosphamide 6 gr/m2, carboplatin 2 gr/m2 with ABMR. Median age of the patients was 40 years. Results: Seventeen patients (74%) underwent two cycles of HDC; 6 received only one cycle due to insurance refusal to pay for C2 (1), toxicity from C1 (4), death on C1(1). There were 2 transplant-related deaths due to fungal infections 1 each on C1 and C2. Four patients achieved complete remission (CR) with Itx, 18 achieved partial remission (PR), and 1 had stable disease (SD). One patient was converted from PR to CR with HDC. There are 9/23 (39%) patients alive and progression-free with median follow-up of 27 months. (range 21-41 + months). Twelve of the 23 (52%) have progressed at a median of 7 months (range 4-32) from bone marrow transplant (BMT) and there were 2 early deaths (9%). Six patients received only one cycle of HDC and 2 of these are alive and progression-free at 36 and 38 months of follow-up. Of the 17 completing two cycles of HDC, 7/17 (41%) are alive and progression-free with follow-up of 21-41 months. The median progression-free survival (PFS) for the entire group is 13 months and median overall survival is 21 months (range 1–41 + mos). Conclusion: Despite the use of two cycles of HDC with ABMR, systemic relapse remains the major obstacle to cure in women with locally advanced breast cancer; there is a need to develop more effective preparative rgimens.