High dose chemotherapy with haematopoietic rescue in breast cancer

High dose chemotherapy (HDC) for breast cancer has been used for some 15 years. All studies demonstrate a high response rate with approximately 20% prolonged (> 3 years) disease free survival among patients who achieved complete remission (CR) following HDC. Debate about the value of HDC has centered around the issue of patient selection, including selection by chemotherapy response. Results of one randomised, published trial of HDC versus conventional dose treatment, however, demonstrate a better outcome for the HDC group with a higher CR rate and prolongation of survival. These results have been updated and continue to show a stable proportion of long term complete remitters. In the adjuvant setting one recent trial has demonstrated no benefit from HDC 'consolidation' in 'high-risk' patients. Results of a number of other studies are pending and will help to settle this issue. The article reviews issues including patient selection by prior chemotherapy response, other methods of selection, the chemotherapy regimens used and the timing of HDC. While additional and confirmatory studies are required HDC for breast cancer remains an effective treatment modality.