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Titolo:
Tandem high-dose chemotherapy in high-risk primary breast cancer: A multivariate analysis and a matched-pair comparison with standard-dose chemotherapy
Autore:
Schneeweiss, A; Goerner, R; Hensel, M; Lauschner, I; Sinn, P; Kaul, S; Egerer, G; Beldermann, F; Geberth, M; Solomayer, E; Grischke, EM; Haas, R; Ho, AD; Bastert, G;
Indirizzi:
Univ Heidelberg, Dept Gynecol & Obstet, D-69115 Heidelberg, Germany Univ Heidelberg Heidelberg Germany D-69115 , D-69115 Heidelberg, Germany Univ Heidelberg, Dept Internal Med 5, D-69115 Heidelberg, Germany Univ Heidelberg Heidelberg Germany D-69115 , D-69115 Heidelberg, Germany Univ Heidelberg, Dept Pathol, D-69115 Heidelberg, Germany Univ HeidelbergHeidelberg Germany D-69115 , D-69115 Heidelberg, Germany Univ Dusseldorf, Dept Hematol & Oncol, D-4000 Dusseldorf, Germany Univ Dusseldorf Dusseldorf Germany D-4000 ol, D-4000 Dusseldorf, Germany
Titolo Testata:
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
fascicolo: 6, volume: 7, anno: 2001,
pagine: 332 - 342
SICI:
1083-8791(2001)7:6<332:THCIHP>2.0.ZU;2-K
Fonte:
ISI
Lingua:
ENG
Soggetto:
PROGENITOR-CELL SUPPORT; BLOOD STEM-CELLS; BONE-MARROW; RANDOMIZED TRIAL; ADJUVANT TREATMENT; TRANSPLANTATION; CYCLOPHOSPHAMIDE; FLUOROURACIL; EPIRUBICIN; SURVIVAL;
Keywords:
high-dose chemotherapy; high-risk primary breast cancer; nodal ratio; HER2/neu;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
31
Recensione:
Indirizzi per estratti:
Indirizzo: Schneeweiss, A Univ Heidelberg, Dept Gynecol & Obstet, Vossstr 9, D-69115 Heidelberg, Germany Univ Heidelberg Vossstr 9 Heidelberg Germany D-69115 rmany
Citazione:
A. Schneeweiss et al., "Tandem high-dose chemotherapy in high-risk primary breast cancer: A multivariate analysis and a matched-pair comparison with standard-dose chemotherapy", BIOL BLOOD, 7(6), 2001, pp. 332-342

Abstract

Stem cell-supported high-dose chemotherapy (HDCT) is currently being evaluated in patients with high-risk primary breast cancer (HRPBC), as defined by extensive axillary lymph node involvement. Conclusive results from randomized studies with sufficient patient numbers and follow-up are pending. We retrospectively analyzed 144 HRPBC patients enrolled in a single-arm trial of tandem HDCT at the University of Heidelberg to evaluate the prognostic value of nodal ratio, HER2/neu status, and cytokeratin-positive bone marrow cells and to compare the outcomes of these patients with those of a conventionally treated control group of 91 patients matched by nodal ratio, tumor size, combined hormone-receptor status, and HER2/neu status. The tandem HDCT regimen consisted of 2 cycles of induction chemotherapy followed by 2 cycles of blood stem cell-supported high-dose ifosfamide, 12 g/m(2); carboplatin, 900 mg/m(2); and epirubicin, 180 mg/m2. Conventionally treated patientsreceived a regimen containing anthracycline without taxanes (52 patients) or CMF (cyclophosphamide, methotrexate, and 5-flurouracil; 39 patients). With a median follow-up of 3.8 years, disease-free, distant disease-free, andoverall survival rates were 62%, 65%, and 84%, respectively. In univariateanalysis, besides the hormone receptor status (P = .007), HER2/neu overexpression was the strongest predictor of earlier death (P = .017). In multivariate analysis, a nodal ratio of greater than or equal to0.8 was found to be the only independent predictor of relapse (relative risk [RR] = 2.09; 95%confidence interval [CI], 1.21-3.60; P = .008) and only the absence of hormone receptors was associated with earlier death (RR = 3.59; 95% CI, 1.45-8.86; P =.006). Despite a trend toward later distant relapse after HDCT compared with standard-dose chemotherapy with a median follow-up of 3 years (P = .059), thus far, matched-pair analysis has not demonstrated significantlybetter survival rates after HDCT in all matched patients (P = .786) or in the subgroups of anthracycline-treated patients and patients with and without overexpression of HER2/neu. So far, the follow-up time has been too short to draw definite conclusions; however, patients with a nodal ratio of greater than or equal to0.8, receptor-negative tumors, or HER2/neu overexpression are at high risk for relapse and death, irrespective of the kind of adjuvant chemotherapy.

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Documento generato il 21/09/20 alle ore 11:26:26