Stage III and oestrogen receptor negativity are associated with poor prognosis after adjuvant high-dose therapy in high-risk breast cancer

• Verfasst von: Hohaus, Stefan [VerfasserIn]
• Verfasst von: Funk, Liane [VerfasserIn]
• Verfasst von: Martin, Simona [VerfasserIn]
• Verfasst von: Schlenk, Richard Friedrich [VerfasserIn]
• Verfasst von: Abdallah Khalafallah, Alhossain [VerfasserIn]
• Verfasst von: Hahn, Uwe [VerfasserIn]
• Verfasst von: Egerer, Gerlinde [VerfasserIn]
• Verfasst von: Goldschmidt, Hartmut [VerfasserIn]
• Verfasst von: Schneeweiss, Andreas [VerfasserIn]
• Verfasst von: Fersis, Nikolaos Erich [VerfasserIn]
• Verfasst von: Kaul, Sepp [VerfasserIn]
• Verfasst von: Wallwiener, Diethelm [VerfasserIn]
• Verfasst von: Bastert, Gunther [VerfasserIn]
• Verfasst von: Haas, Rainer [VerfasserIn]
• Titel: Stage III and oestrogen receptor negativity are associated with poor prognosis after adjuvant high-dose therapy in high-risk breast cancer
• Verf.angabe: S. Hohaus, L. Funk, S. Martin, R. F. Schlenk, A. Abdallah, U. Hahn, G. Egerer, H. Goldschmidt, A. Schneeweiß, N. Fersis, S. Kaul, D. Wallwiener, G. Bastert, R. Haas
• E-Jahr: 1999
• Jahr: 26 February 1999
• Umfang: 8 S.
• Illustrationen: Diagramme
• Fussnoten: Gesehen am 01.03.2022
• Titel Quelle: Enthalten in: British journal of cancer
• Ort Quelle: Edinburgh : Nature Publ. Group, 1999
• Jahr Quelle: 1999
• Band/Heft Quelle: 79(1999), 9, Seite 1500-1507
• ISSN Quelle: 1532-1827
• DOI: doi:10.1038/sj.bjc.6690239
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Biomedicine
• Sach-SW: Cancer Research
• Sach-SW: Drug Resistance
• Sach-SW: Epidemiology
• Sach-SW: general
• Sach-SW: Molecular Medicine
• Sach-SW: Oncology
• K10plus-PPN: 1794188770

Abstract

We report on the efficacy and toxicity of a sequential high-dose therapy with peripheral blood stem cell (PBSC) support in 85 patients with high-risk stage II/III breast cancer. There were 71 patients with more than nine tumour-positive axillary lymph nodes. An induction therapy of two cycles of ifosfamide (total dose, 7.5 g m-2) and epirubicin (120 mg m-2) was given, and PBSC were harvested during G-CSF-supported leucocyte recovery following the second cycle. The PBSC-supported high-dose chemotherapy consisted of two cycles of ifosfamide (total dose, 12 000 mg m-2), carboplatin (900 mg m-2) and epirubicin (180 mg m-2). Patients were autografted with a median number of 3.7 × 106 CD34+ cells kg-1 (range, 1.9-26.5 × 106) resulting in haematological reconstitution within approximately 2 weeks following high-dose therapy. The toxicity was moderate in general, and there was no treatment-related toxic death. Twenty-one patients relapsed between 3 and 30 months following the last cycle of high-dose therapy (median, 11 months). The probability of disease-free and overall survival at 4 years were 60% and 83%, respectively. According to a multivariate analysis, patients with stage II disease had a significantly better probability of disease-free survival (74%) in comparison to patients with stage III disease (36%). The probability of disease-free survival was also significantly better for patients with oestrogen receptor-positive tumours (70%) compared to patients with receptor-negative ones (40%). Bone marrow samples collected from 52 patients after high-dose therapy were examined to evaluate the prognostic relevance of isolated tumour cells. The proportion of patients presenting with tumour cell-positive samples did not change in comparison to that observed before high-dose therapy (65% vs 71%), but a decrease in the incidence and concentration of tumour cells was observed over time after high-dose therapy. This finding was true for patients with relapse and for those in remission, which argues against a prognostic significance of isolated tumour cells in bone marrow. In conclusion, sequential high-dose chemotherapy with PBSC support can be safely administered to patients with high-risk stage II/III breast cancer. Further intensification of the therapy, including the addition of non-cross resistant drugs or immunological approaches such as the use of antibodies against HER-2/NEU, may be envisaged for patients with stage III disease and hormone receptor-negative tumours.