Review identifies factors leading to better outcome for some metastatic breast cancer patients

DURHAM, N.C.--Duke University Medical Center researchers have identified a subset of patients with advanced breast cancer who had greater success than other patients treated with experimental high-dose chemotherapy followed by bone marrow transplant.

In a retrospective review of a previous Duke study of 425 patients, now with an average of six years' follow-up, of the 299 patients who had high-dose chemotherapy with transplant, those patients who had previously received hormone therapy with the drug tamoxifen, but had not previously received chemotherapy and had no tumors beyond the chest wall and lymph nodes were more likely to live longer than the other patients.

The findings of the Duke study, published in the October Journal of Clinical Oncology, can help physicians select which metastatic breast cancer patients might benefit most from aggressive therapy and suggest restructuring follow-up treatment for patients at high risk for recurrence or new spread of disease, according to the authors.

"Right now high-risk patients are followed with a symptom-based approach--if there's a problem or change in symptoms then tests are done to see why," said lead author Dr. David Rizzieri. "Instead, at-risk patients should be followed very closely, with routinely scheduled physical, radiographic and laboratory tests to catch recurrence early, before symptoms appear. We want to hit the disease early, and hit it hard."

Because of its greater toxicity and a dearth of clinical trials comparing it to standard treatments, high-dose chemotherapy with bone marrow transplant is a controversial treatment for breast cancer patients. Nevertheless, many patients have been demanding the treatment, believing it to be their last hope. At the American Society for Clinical Oncology (ASCO) annual meeting in May, other scientists reported preliminary results of an ongoing randomized clinical trial that demonstrated no survival difference between a high-dose treatment grou

Contact: Joanna Downer
Duke University Medical Center

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