High-Dose Chemotherapy in Adult Solid Tumors and Lymphoproliferative Disorders: The Need for Randomized Trials

Area of Science:

• Oncology
• Hematology

Background:

• Growing interest in high-dose chemotherapy (HDC) due to dose-effect relationships in various cancers.
• Advancements in hematopoietic stem cell support have facilitated HDC research.

Purpose of the Study:

• To evaluate the impact of high-dose chemotherapy on patient survival across different malignancies.
• To synthesize findings from published randomized trials on HDC efficacy.

Main Methods:

• Review of nine published randomized trials investigating high-dose chemotherapy.
• Analysis of results from nonrandomized trials involving over 3,000 patients.

Main Results:

• High-dose chemotherapy demonstrates a survival advantage in the salvage treatment of non-Hodgkin's lymphoma and first-line treatment of multiple myeloma for chemosensitive patients.
• Promising, yet inconclusive, results were observed in metastatic breast cancer.
• Limited evidence supports HDC outside of clinical trials for most cancers, excluding multiple myeloma and relapsed non-Hodgkin's lymphoma.

Conclusions:

• High-dose chemotherapy is beneficial as consolidation therapy in specific hematologic malignancies.
• Definitive conclusions for other cancers require results from ongoing randomized trials and cost-effectiveness studies.
• Current evidence does not support the use of high-dose chemotherapy outside of randomized clinical trials for most cancer types.