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Whither high-dose chemotherapy in breast cancer?

DOI: 10.1186/bcr262

Keywords: breast cancer, high-dose chemotherapy

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Abstract:

Our intended pun implies that we have reached a crossroads in high-dose chemotherapy for breast cancer. Is high-dose chemotherapy going anywhere, or should we allow it to wither on the vine? The conclusion of this commentary is that, in its present form, high-dose treatment has not been found to be superior to conventional-dose treatment in either the metastatic or adjuvant setting. However, we should be careful not to 'throw the baby out with the bath water'. Rather, we should look seriously at intensifying chemotherapy with more active drugs, given in different schedules. Our judgement is that using conventional cytotoxic chemotherapy, the approach pioneered by the Memorial Sloan-Kettering Hospital, New York, USA, with 'dose-dense' chemotherapy given in a 'block schedule', is likely to produce the best results [1]. However, there is also now much to be gained from looking at biological agents in combination with conventional chemotherapy, particularly with the recent encouraging results with the use of trastuzumab (Herceptin, Genentech, San Francisco, CA, USA) [2].High-dose chemotherapy in breast cancer has been a controversial issue for some time. Several phase 2 trials showed promising results in patients with chemotherapy-responsive metastatic disease, when the data were compared with the outcome in historical control individuals [3,4]. However, most recently published randomized trials demonstrate a lack of effectiveness in both the adjuvant and metastatic settings [5,6,7,8]. The trials of Bezwoda and coworkers from South Africa [9,10,11,12] remained the only important positive evidence for high-dose chemotherapy, until the publication of the onsite review of the Bezwoda studies [13] and the investigator's admission of serious scientific misconduct. Although international commentators [14,15] have suggested that further trials of high-dose chemotherapy should be carried out, our view is that such studies will have to be innovative enough to persuade oncologica

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