Journal of Clinical Oncology, Vol 10, 657-670, Copyright © 1992 by American Society of Clinical Oncology
High-dose chemotherapy with autologous bone marrow transplantation for the treatment of metastatic breast cancer [published erratum appears in J Clin Oncol 1992 Oct;10(10):1655-8]
DM Eddy
Center for Health Policy, Research, and Education, Duke University, Durham, NC.
PURPOSE: This review was undertaken to examine the evidence of
effectiveness of high-dose chemotherapy and autologous bone marrow
transplantation (HDC/ABMT) for the treatment of metastatic breast cancer
and to compare the magnitudes of the benefits and harms of HDC/ABMT with
those of conventional doses of chemotherapy. DESIGN: Published studies were
reviewed and analyzed. RESULTS: No randomized controlled trials have been
published that evaluate HDC/ABMT. Only one internally controlled study has
been conducted; it demonstrated that HDC/ABMT and conventional treatment
have virtually identical outcomes. Comparisons of uncontrolled clinical
series are confounded by patient selection and other biases. Gross
comparisons indicate that, compared with conventional-dose chemotherapy,
HDC/ABMT achieves (1) higher complete response rates (36% v 8%), (2) higher
overall response rates (70% v 39%), (3) similar median response durations
(8 months v 9.6 months), (4) similar median survival durations (16 months v
16.6 months), and (5) similar overall survival rates (eg, 43% 2-year
survival v 39%). Observations of cases with longer-term disease-free
survival are promising but not conclusive. High-dose chemotherapy with ABMT
has a higher treatment-related mortality rate (5% to 15% v 1%), a high rate
of nonmortal toxicity (approximately 30%), and a high rate of side effects
(approaching 100%). CONCLUSIONS: Firm conclusions are not possible because
of the lack of controlled studies and the presence of numerous biases.
However, the existing evidence does not demonstrate that HDC/ABMT is
superior to conventional-dose chemotherapy for the treatment of metastatic
breast cancer. Randomized controlled trials are needed.
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