High-dose chemotherapy with hematopoietic stem-cell rescue for high-risk breast cancer

Sjoerd Rodenhuis, Marijke Bontenbal, Louk V.A.M. Beex, John Wagstaff, Dick J. Richel, Marianne A. Nooij, Emile E. Voest, Pierre Hupperets, Harm Van Tinteren, Hans L. Peterse, Elisabeth M. TenVergert, Elisabeth G.E. De Vries

Onderzoeksoutput: Bijdrage aan tijdschriftArtikelpeer review

238 Citaten (Scopus)


BACKGROUND: The use of high-dose adjuvant chemotherapy for high-risk primary breast cancer is controversial. We studied its efficacy in patients with 4 to 9 or 10 or more tumor-positive axillary lymph nodes. METHODS: Patients younger than 56 years of age who had undergone surgery for breast cancer and who had no distant metastases were eligible if they had at least four tumor-positive axillary lymph nodes. Patients in the conventional-dose group received fluorouracil, epirubicin, and cyclophosphamide (FEC) every three weeks for five courses, followed by radiotherapy and tamoxifen. The high-dose treatment was identical, except that highdose chemotherapy (6 g of cyclophosphamide per square meter of body-surface area, 480 mg ofthiotepa per square meter, and 1600 mg ofcarboplatin per square meter) with autologous peripheral-blood hematopoietic progenitor-cell transplantation replaced the fifth course of FEC. RESULTS: Of the 885 patients, 442 were assigned to the high-dose group and 443 to the conventional-dose group. After a median follow-up of 57 months, the actuarial 5-year relapsefree survival rates were 59 percent in the conventional-dose group and 65 percent in the high-dose group (hazard ratio for relapse in the high-dose group, 0.83; 95 percent confidence interval, 0.66 to 1.03; P=0.09). In the group with 10 or more positive nodes, the relapse-free survival rates were 51 percent in the conventional-dose group and 61 percent in the high-dose group (P=0.05 by the log-rank test; hazard ratio for relapse, 0.71; 95 percent confidence interval, 0.50 to 1.00). CONCLUSIONS: High-dose alkylating therapy improves relapse-free survival among patients with stage II or III breast cancer and 10 or more positive axillary lymph nodes. This benefit may be confined to patients with HEK-2/neu-negative tumors.

Originele taal-2Engels
Pagina's (van-tot)7-16
Aantal pagina's10
TijdschriftNew England Journal of Medicine
Nummer van het tijdschrift1
StatusGepubliceerd - 3 jul. 2003
Extern gepubliceerdJa


Duik in de onderzoeksthema's van 'High-dose chemotherapy with hematopoietic stem-cell rescue for high-risk breast cancer'. Samen vormen ze een unieke vingerafdruk.

Citeer dit