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| |  Risks of Autologous Stem-Cell Transplantation Outweigh Benefits in Treating High-Risk Breast Cancer: Presented at SABCS By Jennifer Reising SAN ANTONIO, Tex -- December 12, 2009 -- Autologous stem-cell transplantation (ASCT) shows little benefit in the treatment of high-risk breast cancer, and increases toxicity, according to a study presented here at the 32nd Annual San Antonio Breast Cancer Symposium (SABCS). “Our research shows autologous stem-cell transplantation doesn’t improve overall survival and has little improvement in cancer recurrence,” noted Annegret Herrmann-Frank, PhD, Institute for Quality and Efficiency in Health Care, Cologne, Germany, speaking here on December 11. Dr. Herrmann-Frank and colleagues performed a systematic search of randomised, controlled trials in bibliographic databases to determine the risks and benefits of ASCT for women with high-risk breast cancer, defined as having at least 4 involved axillary lymph nodes. The study was designed to compare clinical outcomes, including overall survival (OS), disease-free survival (DFS), and toxicity of ASCT versus standard chemotherapy (CTx) or dose-dense chemotherapy (DD-CTx). The investigators analysed 13 trials, comprising a total of 5,251 high-risk breast cancer patients. Ten of these 13 trials compared single ASCT with CTx, 1 compared ASCT with DD-CTx, and 2 compared tandem ASCT with CTx or DD-CTX, respectively. At 5 years, the meta-analysis study, including 9 out of 10 trials, revealed an absolute difference in rates of DFS of -0.05 in favour of ASCT (95% confidence interval, -0.08 to -0.01; P = .007). Toxicity of grades 3 to 5 was also increased in the groups that had single ASCT. Tandem ASCT showed better outcomes of OS and DFS compared with DD-CTx; however, since this was only observed in 1 trial (WSG AM-01), the advantage of tandem ASCT may be strongly related to the therapy protocol. Both single and tandem ASCT were associated with a higher rate of severe or life-threatening adverse events. “We recommend that high-risk breast cancer patients should no longer be treated with ASCT outside of clinical trials until current protocols are used. The trials that were evaluated in this study used an anthracycline-based chemotherapy protocol, while the current guidelines recommend a taxane-based protocol,” concluded Dr. Herrmann-Frank. [Presentation title: Autologous Stem Cell Transplantation Versus Standard or Dose-Dense Chemotherapy in High Risk Breast Cancer: A Systematic Review. Abstract 2096]
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