|
The Cochrane Collaboration
Cochrane Reviews |
| Explore | New + Updated | Other languages |
|
 |
High dose chemotherapy and autologous bone marrow or stem cell transplantation versus conventional chemotherapy for women with metastatic breast cancerFarquhar C, Marjoribanks J, Basser R, Hetrick SE, Lethaby A
Bookmark this:
     more ...
SummaryHigh dose chemotherapy and autologous bone marrow or stem cell transplantation versus conventional chemotherapy for women with metastatic breast cancerAdvanced or 'metastatic' breast cancer is cancer that has spread beyond the breast and underarm lymph nodes to other parts of the body. Although metastatic breast cancer is often responsive to conventional chemotherapy it does not provide a cure. The dose of chemotherapy that can be given to an individual is limited because it is unsafe in high doses and can seriously damage the bone marrow, leaving the woman susceptible to infection. One treatment that was considered promising at the start of the 1990's used a technique of bone marrow or peripheral stem cell transplantation which used a woman's own tissue (a treatment known as autograft) to regenerate her bone marrow following a course of high dose chemotherapy. The use of this technique allowed the administration of chemotherapy doses many times higher than could otherwise be used. This review aimed to compare the evidence from randomised controlled trials comparing high dose chemotherapy with conventional chemotherapy. This review identified six randomised trials including 438 women receiving high dose chemotherapy with autograft and 413 women receiving conventional chemotherapy treatment. In the group receiving the high dose chemotherapy, there were 15 deaths as opposed to two in the conventional chemotherapy arm. Although the high-dose treatment did not increase overall survival at 5 years compared with conventional treatment, women on the high-dose treatment survived significantly longer before experiencing a recurrence of their cancer. Treatment side-effects were worse in the high-dose group. On the basis of this review, the authors conclude that high dose chemotherapy with bone marrow or stem cell transplantation should not be given to women with metastatic breast cancer outside of clinical trials.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
January 20. 2003 AbstractBackgroundAlthough metastatic breast cancer is often responsive to conventional chemotherapy, it remains ultimately incurable. Autologous transplantation of bone marrow or peripheral stem cells (in which the patient is both donor and recipient) has been considered a promising technique because it allows much higher doses of chemotherapy to be used. ObjectivesTo compare the effectiveness of high dose chemotherapy and autologous bone marrow or stem cell transplantation (autograft) with conventional chemotherapy for women with metastatic breast cancer. Outcomes were survival rates, treatment-related toxicity and quality of life. Search strategyWe used the Cochrane Breast Cancer Group search strategy, adding these terms: bone marrow transplantation, stem cell transplantation, autologous stem cell support. The following databases were searched: MEDLINE and EMBASE (until March 2007), ASCO (American Society of Clinical Oncology) (1995-2007) and the COCHRANE LIBRARY (Issue 1 2007). We searched the Cochrane Breast Cancer Group database and cooperative research groups' websites for unpublished trials and checked the reference lists of articles found. Selection criteriaRandomised controlled trials comparing the effectiveness of high dose chemotherapy and autograft with conventional chemotherapy for women with metastatic breast cancer. Data collection and analysisSix randomised controlled trials met the inclusion criteria. Two independent reviewers extracted data. Main resultsIn total 438 eligible women were randomised to receive high dose chemotherapy with autograft and 413 were randomised to receive conventional treatment. There were fifteen treatment-related deaths among the high dose group and two in the control (conventional dose) group (RR 4.08 (95% CI 1.39, 11.91)). There was no statistically significant difference in overall survival between the high dose and control groups at one year, three years or five years. At one and five years of follow up, there was a statistically significant difference in event-free survival, favouring the high dose group (one year: RR 1.56 (95% CI 1.15, 2.13); five years: RR 2.84 (95% CI 1.07, 7.50). Toxicity was more severe in the high dose group. Only one of the trials has followed up all women for five years. Authors' conclusionsAlthough there is statistically significant evidence that high dose chemotherapy and autograft improves event free survival compared to conventional chemotherapy, there is no statistically significant evidence of benefit in overall survival for women with metastatic breast cancer. High dose chemotherapy with bone marrow or stem cell transplantation should not be given to women with metastatic breast cancer outside of clinical trials. |