Randomized trial of high-dose chemotherapy and hematopoietic progenitor-cell support in operable breast cancer with extensive lymph node involvement: Final analysis with 7 years of follow-up

Background: The aim of this study was to present an update of overall (OS) and disease-free survival (DFS) and to evaluate the correlation between outcome and pathological findings at surgery in a randomized trial of high-dose chemotherapy following neoadjuvant chemotherapy and surgery in high-risk breast cancer patients. Patients and methods: Ninety-seven women <60 years of age with breast cancer and extensive axillary lymph node involvement received three courses of FE₁₂₀C (5-fluorouracil 500 mg/m², epirubicin 120 mg/m², cyclophosphamide 500 mg/m²) followed by surgery. Eighty-one patients were randomized to receive either a fourth FE₁₂₀C course alone or a fourth FE₁₂₀C course followed by high-dose chemotherapy (cyclophosphamide 6 g/m², thiotepa 480 mg/m², carboplatin 1600 mg/m²). We performed a univariate analysis on possible prognostic factors and analyzed the sites of relapse. Results: After a median follow-up of 6.9 years, 47 (48%) patients were alive, of whom 36 (38%) were without disease. Sixty patients relapsed after treatment. One patient died of myelodysplastic syndrome, without a relapse. In intention-to-treat analysis, the 5-year DFS rates were 47.5% in the conventional treatment arm and 49% in the high-dose arm, and the 5-year OS rates were 62.5% and 61%, respectively. In the univariate analysis, the clinical T-stage before chemotherapy and the number of tumor-positive axillary lymph nodes after induction chemotherapy (P = 0.027) were significant prognostic factors for OS. The same factors (both P = 0.06) plus the estrogen receptor (P = 0.08) were borderline significant factors for DFS. Conclusions: After a median follow-up of 6.9 years there was no difference in OS or DFS rates between the two treatment groups. The number of tumor-positive axillary lymph nodes after induction chemotherapy and the clinical T-stage before chemotherapy were significant factors for OS.