20-Year Data Link High-Dose Chemotherapy and Hematopoietic Stem Cell Transplant to Survival Benefit in High-Risk Early Breast Cancer

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A 20-year follow-up demonstrated a continued survival benefit with HDCT with HSCT for patients with early breast cancer and at least 9 involved axial lymph nodes.
A 20-year follow-up demonstrated a continued survival benefit with HDCT with HSCT for patients with early breast cancer and at least 9 involved axial lymph nodes.
The following article features coverage from the European Society for Medical Oncology (ESMO) 2018 meeting. Click here to read more of Cancer Therapy Advisor's conference coverage.

Adjuvant high-dose chemotherapy (HDCT) with hematopoietic stem cell transplant (HSCT) may be beneficial for patients with high-risk early breast cancer with more than 9 involved axial lymph nodes (ALN),according to a study presented at the 2018 ESMO Congress in Munich, Germany.1

Though conventional chemotherapy is preferred over HDCT in most patients with high-risk early breast cancer due to toxicity, there may be a benefit for very high-risk patients. The aim of this study was to evaluate long-term outcomes of women who received HDCT and HSCT in a phase 3 trial.

The phase 3 trial was conducted between 1993 to 1999 and randomly assigned 885 women younger than 56 with early breast cancer and at least 4 involved ALN to receive conventional chemotherapy with fluorouracil, epirubicin, and cyclophosphamide or HDCT followed by autologous HSCT. The HDCT regimen was similar to the conventional regimen, but replaced the last cycle with high-dose cyclophosphamide, thiotepa, and carboplatin.

In the overall cohort, there was no difference in relapse or death between the arms, with rates of 61% and 58% in the conventional chemotherapy and HDCT arms, respectively (hazard ratio [HR], 0.88; 95% CI, 0.74-1.05) after a median follow-up of 20 years. Outcomes were also similar among patients with ER-positive or HER2-positive disease.

Among patients with more than 9 involved ALN, however, HDCT significantly improved outcomes. The relapse-free survival rate (RFS) was 39% in patients who received HDCT compared with 27% after conventional chemotherapy (HR, 0.71; 95% CI, 0.54-0.94;P= .02). HDCT also significantly prolonged overall survival (OS), with a 20-year survival rate of 44% compared with 30% with conventional chemotherapy (HR, 0.72; 95% CI, 0.95; P= .02).

There was no significant difference in RFS or OS in the TNBC cohort, but there was a trend toward a benefit. The RFS was 51% and 34% with HDCT and conventional treatment (HR, 0.66; 95% CI, 0.42-1.03; P= .07). The 20-year OS was 52% and 39% with HDCT or conventional chemotherapy, respectively (HR, 0.71; 95% CI, 0.45-1.12; P= .14). 

The authors concluded that this “long-term follow-up confirms survival benefit of HDCT in breast cancer patients with [more than] 9 involved ALN and suggests benefit in TNBC patients.”

Read more of Cancer Therapy Advisor's coverage of the ESMO 2018 meeting by visiting the conference page.

Reference

  1. Steenbruggen TG, Steggink LC, Seynaeve CM. High-dose chemotherapy (HDCT) with hematopoietic stem cell transplantation (HSCT) in high-risk breast cancer (BC) patients with ≥4 involved axillary lymph nodes (ALN): 20-year follow-up of a randomized phase 3 study. Presented at: 2018 ESMO Congress; Munich, Germany: October 19-23, 2018. Abstract 187O.

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