High-dose chemotherapy with autologous stem cell support for breast cancer

High-dose chemotherapy is increasingly utilized for the treatment of metastatic and high-risk breast cancer. Autologous Blood and Marrow Transplant Registry data reveal that a single high-dose cycle of chemotherapy with stem cell support can produce high complete response rates, with 10% to 20% of patients disease-free at 5 years. For patients with locally advanced disease, pooled results estimate 63% without relapse at 3 years for stage II and III disease and 42% for inflammatory breast cancer. New strategies to improve on these results include the incorporation of newly identified active drugs into established regimens and the use of multiple high-dose cycles. Multicycle chemotherapy produces complete response rates ranging from 35% to 93% depending on the regimen. Additional strategies include the use of monoclonal antibodies, immunotherapy, and gene therapy for post-transplant consolidation. The strongest predictor of long-term disease-free survival in virtually all studies is a complete response prior to or following high-dose chemotherapy. Randomized studies are now in the process of being completed in Europe and the United States with reporting scheduled over the next several years.