High dose chemotherapy with stem cell rescue for breast cancer: current status and future directions

Dose intensification of particular chemotherapy agents can produce high, complete and overall response rates in women with locally advanced or metastatic breast cancer. High dose chemotherapy with stem cell rescue is currently a controversial strategy, not only as a component of the standard of care, but even as an investigative field. This review covers the preclinical and clinical underpinnings of high dose therapy for breast cancer, including selected phase II trials and the phase III trials reported to date in both metastatic and locally advanced breast cancer. Proof of principle for the clinical utility of this approach requires further maturation of data and completion of ongoing randomized trials. Nonetheless, the clinical results are sufficiently compelling to support ongoing research and grants, particularly in the effort to develop multicycle high dose approaches and to integrate new agents and new modalities, such as immunotherapy, into the framework of high dose therapy.