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Advanced Breast Cancer, Higher Chemo?

Study Shows Better Survival With High-Dose Chemo
By
WebMD Health News

Dec. 1, 2005 -- What's the best dose of chemotherapy for people with advanced breast cancer?

The latest research may offer some leads. But more studies are needed to find out, write researchers in The Lancet.

Specifically, the question is whether high doses of chemotherapy improve survival. That's the topic of a four-year study published in The Lancet.

The bottom line: More patients survived without cancer's return after high-dose chemotherapy, compared with those who got standard chemo doses.

However, researcher Ulrike Nitz, MD, and colleagues, aren't calling for changes in treatment. "This approach merits further study," they write.

Nitz works in Germany at the University of Dusseldorf's Breast Centre.

Surviving Breast Cancer

The study included 403 people with advanced breast cancer. Their cancer had extensively spread to their lymph nodes.

One of the patients was a man. Men can get breast cancer, but the majority of patients are women.

Half of the patients got high doses of chemotherapy plus a stem cell transplant to replace immune system cells killed by the high-dose chemotherapy. The others got conventional chemotherapy. All had already had surgery (lumpectomy or mastectomy) for their breast cancer. They also got radiation afterward.

In addition, all patients who had hormone-sensitive breast cancer took tamoxifen after radiation.

Patients were about 48 years old. Half of the women in each group were postmenopausal. Their cancers were similar in size and scope.

High Dose vs. Normal Dose

The high-dose cancer group had better cancer-free survival rates over four years:

  • Cancer-free survival, high-dose group: 60%
  • Cancer-free survival, standard-dose group: 44%

Overall survival (with or without cancer) was also higher in the high-dose group:

  • Overall survival, high-dose group: 75%
  • Overall survival, standard-dose group: 70%

Side effects of chemotherapy (such as nausea, vomiting, and skin reactions) were greater in the high-dose group. No severe side effects were reported.

One patient who switched to the high-dose group developed leukemia nearly three years after her second round of chemotherapy and later died. The researchers don't attribute that death to chemotherapy.

More Work Ahead

Other studies have been done, but the designs of those studies haven't been the same. That's made it hard to identify a single, promising strategy, write the researchers.

"Nevertheless, the superiority of high-dose chemotherapy in our trial suggests that this strategy remains valid for further investigation," Nitz and colleagues conclude.

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