Induction, mobilization of peripheral blood stem cells (PBSC), high-dose chemotherapy and PBSC infusion in patients with untreated stage IV breast cancer: Outcomes by intent to treat analyses

C. H. Weaver, W. H. West, Lee Schwartzberg, T. Alberico, R. Leff, F. A. Greco, J. Hainsworth, R. Birch, B. McAneny, M. Magee, E. Raefsky, L. Kalman, C. D. Buckner

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Abstract

We investigated the outcomes of patients with breast cancer undergoing induction chemotherapy, mobilization of peripheral blood stem cells (PBSC) and high-dose chemotherapy (HDC) with PBSC infusion. One hundred and fourteen patients with untreated stage IV breast cancer, with a median age of 46 years (range 24-62), were entered on a phase II trial consisting of: (1) doxorubicin, 5-flurouracil, methotrexate (AFM) x 4 courses at 2 week intervals; (2) cyclophosphamide (4 g/m2), etoposide (600 mg/m2), cisplatin (105 mg/m2) (CEP), filgrastim (6 μg/kg/day) and PBSC collection; (3) cyclophosphamide (6 g/m2), thiotepa (500 mg/m2), carboplatin (800 mg/m2) (CTCb) followed by PBSC infusion. All patients received AFM, 107 (94%) received CEP, 93 (82%) received CTCb and PBSC as per protocol and 99 (87%) ultimately received HDC and PBSC. There was one infectious death after AFM and all other deaths were associated with progressive disease. Fifty-two patients (46%) are alive, 21 (18%) without progression, at a median 31 months (range 22-47). The probabilities of survival and progression-free survival at 3.5 years were 0.40 and 0.17, respectively. All 62 patients with visceral disease and/or a prior history of doxorubicin adjuvant therapy have relapsed or progressed. We conclude that the sequential administration of AFM, CEP and CTCb followed by PBSC resulted in long-term PFS only in patients who were NED, had bone-only disease or had lymph node or soft tissue disease with or without bone disease. Other strategies, aimed at improving responses to initial therapy, improving HDC regimens and/or developing immunomodulatory therapies, will be necessary to improve PFS for patients who fail doxorubicin adjuvant or who have visceral disease.

Original languageEnglish (US)
Pages (from-to)661-670
Number of pages10
JournalBone Marrow Transplantation
Volume19
Issue number7
DOIs
StatePublished - Apr 1 1997

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Breast Neoplasms
Drug Therapy
Doxorubicin
Bone Diseases
Cyclophosphamide
Thiotepa
Induction Chemotherapy
Immunomodulation
Carboplatin
Etoposide
Peripheral Blood Stem Cells
Methotrexate
Cisplatin
Disease-Free Survival
Lymph Nodes
Survival
Therapeutics

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

Cite this

Induction, mobilization of peripheral blood stem cells (PBSC), high-dose chemotherapy and PBSC infusion in patients with untreated stage IV breast cancer : Outcomes by intent to treat analyses. / Weaver, C. H.; West, W. H.; Schwartzberg, Lee; Alberico, T.; Leff, R.; Greco, F. A.; Hainsworth, J.; Birch, R.; McAneny, B.; Magee, M.; Raefsky, E.; Kalman, L.; Buckner, C. D.

In: Bone Marrow Transplantation, Vol. 19, No. 7, 01.04.1997, p. 661-670.

Research output: Contribution to journalArticle

Weaver, C. H. ; West, W. H. ; Schwartzberg, Lee ; Alberico, T. ; Leff, R. ; Greco, F. A. ; Hainsworth, J. ; Birch, R. ; McAneny, B. ; Magee, M. ; Raefsky, E. ; Kalman, L. ; Buckner, C. D. / Induction, mobilization of peripheral blood stem cells (PBSC), high-dose chemotherapy and PBSC infusion in patients with untreated stage IV breast cancer : Outcomes by intent to treat analyses. In: Bone Marrow Transplantation. 1997 ; Vol. 19, No. 7. pp. 661-670.
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abstract = "We investigated the outcomes of patients with breast cancer undergoing induction chemotherapy, mobilization of peripheral blood stem cells (PBSC) and high-dose chemotherapy (HDC) with PBSC infusion. One hundred and fourteen patients with untreated stage IV breast cancer, with a median age of 46 years (range 24-62), were entered on a phase II trial consisting of: (1) doxorubicin, 5-flurouracil, methotrexate (AFM) x 4 courses at 2 week intervals; (2) cyclophosphamide (4 g/m2), etoposide (600 mg/m2), cisplatin (105 mg/m2) (CEP), filgrastim (6 μg/kg/day) and PBSC collection; (3) cyclophosphamide (6 g/m2), thiotepa (500 mg/m2), carboplatin (800 mg/m2) (CTCb) followed by PBSC infusion. All patients received AFM, 107 (94{\%}) received CEP, 93 (82{\%}) received CTCb and PBSC as per protocol and 99 (87{\%}) ultimately received HDC and PBSC. There was one infectious death after AFM and all other deaths were associated with progressive disease. Fifty-two patients (46{\%}) are alive, 21 (18{\%}) without progression, at a median 31 months (range 22-47). The probabilities of survival and progression-free survival at 3.5 years were 0.40 and 0.17, respectively. All 62 patients with visceral disease and/or a prior history of doxorubicin adjuvant therapy have relapsed or progressed. We conclude that the sequential administration of AFM, CEP and CTCb followed by PBSC resulted in long-term PFS only in patients who were NED, had bone-only disease or had lymph node or soft tissue disease with or without bone disease. Other strategies, aimed at improving responses to initial therapy, improving HDC regimens and/or developing immunomodulatory therapies, will be necessary to improve PFS for patients who fail doxorubicin adjuvant or who have visceral disease.",
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AU - Schwartzberg, Lee

AU - Alberico, T.

AU - Leff, R.

AU - Greco, F. A.

AU - Hainsworth, J.

AU - Birch, R.

AU - McAneny, B.

AU - Magee, M.

AU - Raefsky, E.

AU - Kalman, L.

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