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Multicycle High-Dose Chemotherapy and Filgrastim-Mobilized Peripheral-Blood Progenitor Cells in Women With High-Risk Stage II or III Breast Cancer: Five-Year Follow-Up

From the Centre for Developmental Cancer Therapeutics, Parkville, Victoria Australia (affiliates: Austin Ludwig Oncology Unit, Austin Repatriation Medical Centre; Melbourne Tumor Biology Branch, Ludwig Institute for Cancer Research; Department of Hematology and Medical Oncology, Department of Surgery, Rotary Bone Marrow Research Laboratories, Royal Melbourne Hospital; Walter and Eliza Hall Institute for Medical Research); Division of Hematology, Hanson Centre for Cancer Research, IMVS, South Australia; Departments of Medical Oncology and Surgery, Royal Adelaide Hospital, South Australia; Department of Hematology, Royal Brisbane Hospital, Queensland; and Bone Marrow Transplant Unit, Alfred Hospital, Victoria.

Address reprint requests to Dr Russell Basser, Director, CDCT, c/o Post Office, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia; Email basser{at}licre.ludwig.edu.au

PURPOSE: To determine the safety and efficacy of multiple cycles of dose-intensive, nonablative chemotherapy in women with poor-prognosis breast cancer.

PATIENTS AND METHODS: Women with stage II breast cancer and 10 or more involved nodes or four or more involved nodes and estrogen receptor–negative tumors and women with stage III disease received three cycles of epirubicin 200 mg/m² and cyclophosphamide 4 g/m², with progenitor cell and filgrastim support every 28 days (n = 79) or 21 days (n = 20). Patients were reviewed at least twice yearly thereafter. Twenty-six patients had bone marrow and apheresis collections assessed for the presence of micrometastatic tumor cells.

RESULTS: Ninety-nine women (median age, 43 years; range, 24 to 60 years) were treated. Ninety-two completed all three cycles of chemotherapy. The major toxicity was severe, reversible myelosuppression that was more prolonged with successive cycles, and this did not differ between patients given treatment every 28 days and those treated every 21 days. Febrile neutropenia occurred in 176 (61%) of 287 cycles. Severe mucositis (grade 3 or 4) occurred in 23% of cycles but tended to be short-lived and was reversible. The cardiac ejection fraction fell by a median of 4% during treatment, and three patients developed evidence of cardiac failure after chemotherapy. Two patients (2%) died of acute toxicity. Three of 26 patients had evidence of circulating micrometastatic tumor cells. The actuarial distant disease-free and overall survival rates at 60-month follow-up were 64% (95% confidence interval [CI], 53% to 75%) and 67% (95% CI, 56% to 78%), respectively.

CONCLUSION: Multiple cycles of dose-intensive, nonablative chemotherapy is a feasible and safe approach. Disease control and survival are similar to those in other studies of myeloablative chemotherapy in poor-prognosis breast cancer. The regimen is being evaluated in a randomized trial of the International Breast Cancer Study Group.

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