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High-dose chemotherapy for breast cancer

Bone Marrow Transplantation volume 26, page 599 (2000)Cite this article

A recent editorial in the New Engl J Med relating to the clinical trial in Philadelphia concluded that high-dose chemotherapy and autologous bone marrow transplantation is ineffective in treating metastatic breast cancer and should be abandoned in favour of alternative experimental approaches.12 It signalled a culmination in the controversy on this topic and heralded a swift switch from scientific to political and economic discussions. Health care agencies and medical care providers may now be tempted to refuse reimbursement for such procedures on the basis of this statement. The transplant community is criticised for their neglect of economic issues. It would be preferable to present a more balanced picture. There are indeed solid arguments against such premature reactions.

In fact, the observation time in the Philadelphia study is short, the number of patients is small and extrapolation of results to patients transplanted in earlier stages of the disease is not justified. In addition, the study shows that one single course of high-dose intensification is as effective and equally toxic as a repetitive treatment over 24 months. Treatment of metastatic breast cancer remains a difficult challenge and easy alternatives are not just around the corner. Transplant strategies can be improved. It would be wrong to abandon this form of therapy at this timepoint.

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References

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Authors and Affiliations

  1. Division of Hematology, Department of Research, EBMT Activity Survey Office, Kantonsspital, Basel, CH-4031, Switzerland

    A Gratwohl & H Baldomero

  2. Department of Oncology and Hematology, EBMT Working Party Solid Tumours, Ospedale Civile, Viale Randi 5, Ravenna, I-48100, Italy

    G Rosti

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  1. A Gratwohl
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  2. H Baldomero
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  3. G Rosti
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Gratwohl, A., Baldomero, H. & Rosti, G. High-dose chemotherapy for breast cancer. Bone Marrow Transplant 26, 599 (2000). https://doi.org/10.1038/sj.bmt.1702597

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  • DOI: https://doi.org/10.1038/sj.bmt.1702597

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