High-Dose Chemotherapy Does Not Prolong Life in Breast Cancer Patients, Studies Find
A high-dose chemotherapy regimen for breast cancer patients in advanced stages of the disease does not appear to prolong survival but may reduce the rate of relapse, according to two studies published today in the New England Journal of Medicine, the Wall Street Journal reports. The studies, one conducted in the Netherlands and one conducted in the United States, compared the effectiveness of high-dose treatment with that of conventional chemotherapy for patients whose cancer had spread to their lymph nodes (Golden, Wall Street Journal, 7/3). High-dose chemotherapy kills breast cancer cells but also kills bone marrow cells, the Los Angeles Times reports. To offset the risk of anemia or infection from that loss, after the high-dose treatment patients receive an infusion of stem cells collected from their own bodies or a donor before chemotherapy begins (Maugh, Los Angeles Times, 7/3).
In the first study, Dr. Sjoerd Rodenhuis and colleagues in the Netherlands administered either conventional or high-dose treatment to 885 patients ages 55 and younger who had breast cancer that had spread to four or more lymph nodes. They found that 65% of those who received high-dose treatment did not have a relapse within five years, compared with 59% of those who received conventional treatment. In participants whose cancer had spread to 10 or more lymph nodes, 61% of high-dose patients did not experience a relapse, compared with 51% of traditional chemotherapy participants. However, researchers found "no significant difference in overall survival" between the two groups of participants within the five-year period (Wall Street Journal, 7/3). In the second study, Dr. Martin Tallman and colleagues at Northwestern University Feinberg School of Medicine administered six cycles of standard chemotherapy to 511 women whose breast cancer had spread to 10 or more lymph nodes; some participants then received high-dose chemotherapy treatment (Nano, AP/Las Vegas Sun, 7/3). Researchers found that after six years, 55% of those in the high-dose group did not have a relapse, compared to 48% of standard chemotherapy recipients, which is "not a significant difference," Healthday News/Fort Worth Star-Telegram reports. In addition, they found a survival rate of 62% among standard treatment participants, compared to 58% among high-dose participants, which also is not considered statistically significant (Gardner, Healthday News/Fort Worth Star-Telegram, 7/3).
The studies "confirm earlier findings that high-dose chemotherapy followed by a bone marrow transplant is not an effective way to treat breast cancer," the Times reports. In 1999, five studies conducted in various countries evaluating the use of high-dose chemotherapy in combination with bone marrow transplants in women with advanced breast cancer also suggested that the procedure does not prolong survival (Los Angeles Times, 7/3). Dr. Harmon Eyre, chief medical officer of the American Cancer Society, said, "[T]he evidence of benefit is so minimal, ... the toxicity is so substantial and the cost so high that by and large people are going to say this approach is now no longer worthy of pursuing in any major way." However, Rodenhuis, author of the Netherlands Cancer Institute study, said the treatment might be effective for patients whose tumors do not contain a defect in a gene known as HER2-neu. "We believe that high-dose chemotherapy is going to be back -- but obviously not for all patients," Rodenhuis said. In an accompanying editorial, Dr. Gerald Elfenbein of Roger Williams Medical Center wrote that some women might benefit from high-dose treatment, adding that the studies had not considered race or ethnicity among participants (AP/Las Vegas Sun, 7/3). An abstract of the Dutch study is available online. An abstract of the U.S. study is available online.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.