A recent study led by Dr. David A. Rizzieri of Duke
University Medical Center revealed that the early use of high-dose
chemotherapy and other aggressive treatment of metastatic breast
cancer may significantly improve a patient’s outcome, compared to
standard-dose chemotherapy.
The study, conducted between 1987-1995, tracked 425 women
with metastatic breast cancer (cancer that has spread to distant
parts of the body) who had been previously treated with
standard-dose chemotherapy. 113 of the women enrolled in the study
went into complete remission after treatment while 202 had a partial
response to the treatment. Dr. Rizzieri’s group then took the
patients who had completely responded to the chemotherapy and
randomly assigned them into two groups: one group would receive
high-dose chemotherapy (or other aggressive treatments) while the
other group would not receive any treatment until breast cancer
symptoms reappeared. In addition, all of the women who had partial
responses to standard-dose chemotherapy were given high-dose
chemotherapy.
Of the 425 metastatic
breast cancer patients who entered the trial, 11% remain disease
free after five years. Of all the patients who received a regimen of
standard chemotherapy followed immediately by high dose therapy and
autologous stem cell support, 16% remain disease free after five
years. Autologous stem cell rescue involves the use of the patient's
own blood to obtain stem cells, the precursors of all blood cells.
Stem cells will regenerate bone marrow function in the patient after
high-dose chemotherapy. "If a patient attains a complete response by
the end of the whole therapy, there is a 28% chance of remaining
free of disease through five years," Dr. Rizzieri told Imaginis.net.
Early
aggressive treatment may result in increased treatment
success
In contrast to the customary method of offering standard
chemotherapy and then waiting to see if symptoms of further cancer
involvement develop, Dr. Rizzieri and his colleagues believe that
aggressively treating early metastases, when the disease is minimal,
results in significantly better prognoses for patients.
"We feel that those who are candidates for, and interested in
an aggressive approach to their care if metastatic disease is found
should be followed closely to find the metastatic disease before it
is more advanced and more difficult to get to remission," said Dr.
Rizzieri.
Dr. Rizzieri noted specific factors that predict a better
chance of longer remission with high-dose chemotherapy:
- a long period of time between initial diagnosis of breast
cancer to the diagnosis of metastases, indicating a slower rate of
cancer spreading
- prior use of the breast cancer treatment drug tamoxifen
- hormone receptors positivity (respond well when stimulated)
- smaller size of metastatic cancers
- metastases limited to the chest wall/nodes as opposed to
the visceral organs (the internal organs, mainly stomach and
intestines)
The Duke study could lead to significant advancements in the
way breast cancer patients with metastases are treated. "We feel
that [an aggressive approach] leads to a remission or at least to a
position of a minimum amount of residual disease for the patient.
[At this point] we can use this as a springboard for combining it
with future improvements in alternative therapies including tumor
vaccines and an anti-angiogenesis approach which our group is now
focusing on." Angiogenesis is the ability to grow blood vessels; a
common feature of cancerous tissue Click here for more information
on angiogenesis and a new drug, angiostatin, being developed to
treat cancer.
Recovery, reduction of side
effects
Dr. Rizzieri’s study required approximately three weeks of
recovery for patients at the Duke outpatient transplant center,
followed by several weeks of recovery at home to improve nutrition,
endurance, and strength after exposure to high-dose chemotherapy.
The side effects of chemotherapy typically included increased risk
of infections and severe lung scarring. "Recognition of these risks
has led to a significant decrease in severe side effects from this
procedure today, as compared to when the study was begun ten years
ago," noted Dr. Rizzieri.
Though the study does not specifically address patients with
early stages of breast cancer such as
ductal carcinoma in
situ (DCIS),
the collected data has led to trials with women with earlier stage
breast cancer and multiple axillary lymph nodes. "Those [women] with
early stage disease should be counseled that there are multiple
ongoing trials with standard therapies as well as high-dose therapy
for their disease," said Dr. Rizzieri. "They should make the choice
that best fits their desires for degree of risk/aggressiveness of
care and potential benefits based on preliminary data."
References and additional resources:
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