Survey Builds Case for Transplants in Breast Ca

PARIS, France--Since 1991, breast cancer has been the most commondiagnosis for which bone marrow transplants are performed. Therapy-relatedmortality has plunged to 6% or less, and the procedure's popularityhas grown steadily to the point where more than a quarter of transplantsfor breast cancer are now done in women receiving adjuvant chemotherapyfor stages II and III disease.

Although data from controlled, randomized trials are not yet available,results of a survey of 42 American transplant centers suggestthe advantages of high-dose chemotherapy supported by transplant,said William P. Peters, MD, president, Michigan Cancer Foundation.

Dr. Peters' survey compared outcomes in 2,601 transplant recipientswith published data on similar breast cancer populations thathad been treated with conventional dose therapy.

Speaking at the Fifth International Congress on Anti-Cancer Chemotherapy,he reported that in 1,939 patients with metastatic breast cancerwho received transplants, 5-year overall survival was roughly30% in women with stage IV disease and nearly 60% in women withstage IIIB disease.

When the data were broken down by tumor responsiveness, medianoverall survival was 2.6 years for women with chemosensitive tumors,1.87 years for partial responders, and 1.27 years for nonresponders.

Even among women with hormone-insensitive tumors, approximately33% were alive after 3 years and 25% survived as long as 5 years."Compared to our usual results in metastatic disease, thesedata are not too disappointing," Dr. Peters said.

In contrast, in a cohort of 91 patients with hormone-receptor-negativetumors who were treated with conventional therapy at M.D. Anderson,3-year survival was 19%, and 5-year survival was 8%. Moreover,Dr. Peters said, 3-year survival was only 5% in 64 estrogen-receptor-negativepatients identified in two published CALGB series, and only 8%in 39 receptor-negative patients previously reported in a SWOGseries.

"Although these comparisons need to be done in a much morecarefully controlled fashion, at least there is no evidence thattransplant is any worse than conventional therapy in terms ofoverall survival," he said.

Dr. Peters went on to describe equally striking survival advantagesin 662 women with a median of 13 positive nodes who received adjuvanthigh-dose chemotherapy and transplants at 33 of the centers surveyed.

"The overall survival was just under 80% at 5 years, andevent-free survival was just under 70%," he said. In contrast,he pointed out, conventional therapy in the high-risk adjuvantsetting yields 5-year disease-free and overall survival ratesof 30% and 40%, respectively.

Dr. Peters suggested that transplantation may prove preferableto more intensive treatment regimens without transplant in termsof quality of life. "The question arises as to which is easierto tolerate--6 months of therapy with doxorubicin, 90 mg/m²,followed by 4 months of therapy with intensive Taxol [paclitaxel],or a single transplant over a period of 3 to 4 weeks," hesaid.