Long-term survival after high-dose chemotherapy followed by peripheral stem cell rescue for high-risk, locally advanced/inflammatory, and metastatic breast cancer.

Publication Type:

Journal Article

Source:

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (2012)

Keywords:

2012, Consortium Authored Paper

Abstract:

Patients with high-risk locally-advanced/inflammatory and oligometastatic (≤3 sites) breast cancer frequently relapse or experience early progression. High-dose chemotherapy combined with peripheral stem cell rescue may prolong progression/relapse-free (PFS/RFS) and overall survival (OS). For this study, patients initiated high-dose chemotherapy with STAMP-V (carboplatin, thiotepa, and cyclophosphamide), ACT (doxorubicin, paclitaxel, and cyclophosphamide), or tandem melphalan and STAMP-V. Eighty-six patients were diagnosed with locally-advanced/inflammatory (17 inflammatory), and 12 with oligometastatic breast cancer. Median follow-up was 84 months (range 6-136) for locally-advanced patients; 40 months (range 24-62) for metastatic patients. Five-year RFS and OS for locally-advanced patients were 53% (95% CI 41%-63%) and 71% (95% CI 60%-80%). Hormone receptors were positive in 74% of locally-advanced patients; HER2 was overexpressed in 23%. In multivariate analysis hormone receptor-positive disease and lower stage were associated with better five-year RFS (60% for ER/PR+ vs. 30% for ER/PR-, p<0.01) and OS (83% for ER/PR+ vs. 38% for ER/PR-, p<0.001). Three-year PFS and OS were 49% (95% CI 19%-73%) and 73% (95% CI 38%-91%), respectively, for metastatic patients. Favorable long term RFS/PFS and OS for high-dose chemotherapy with peripheral stem cell rescue in this selected patient population reflect the relative safety of the procedure and warrant validation in defined subgroups through prospective, randomized, multi-institutional trials.