Researchers at the Medical Center have identified a subset of patients with advanced breast cancer who respond successfully to the experimental treatment of high-dose chemotherapy followed by bone marrow transplant.
The controversial results-which will appear in the October issue of the Journal of Clinical Oncology-could assist physicians in selecting patients to treat intensively for breast cancer.
"In this review, we looked at a wide variety of factors that could potentially affect a patient's chance of success with intense, high-dose chemotherapy and bone marrow transplant," said lead author Dr. David Rizzieri, assistant professor in the oncology division of the Department of Medicine. "That way we could identify which metastatic cancer patients would benefit most from the treatment."
The research uses a set of patients who were part of a previous study, which ran from 1987 to 1995. Of the 425 patients in the original study, researchers were able to discern who had a greater chance of success with the therapy, and how to improve monitoring of those patients at high risk for recurrence or spreading of the cancer.
The patients were divided into three groups based on how they responded to the original clinical trial of standard chemotherapy. The progressive group-which showed no signs of response to the treatment-was taken off chemotherapy. The other two groups-the partial responders and the complete responders-received high-dose therapy followed by bone marrow transplant.
"Up front, everyone was treated the same and then they went on a different path," said Gloria Broadwater, co-author of the study and a senior statistician at Duke's cancer center.
Although this procedure may prove to be extremely beneficial, Rizzieri noted that high-dose chemotherapy for breast cancer patients is controversial.
Other leaders in the medical community are skeptical about the potential benefits of the study. "I think that this is a highly charged subject and that there's a great deal of smoke about the value of this high-dose chemotherapy," said Dr. Laurence Baker, director of clinical research at the University of Michigan Cancer Center. "The question is whether there is any redeeming value in this therapy."
Baker noted that the Duke study is consistent with previous studies, which indicate that patients with slower disease growth and longer survival will respond better to treatment. "But that's not where the controversy lies," he said. "Many people don't think that the high costs of this treatment are warranted given the low number of patients who can potentially benefit from it."
Rizzieri recognized some of these concerns. "This is a small baby step forward for some, but it doesn't affect all breast cancer patients," he said. "You combine that with the intensity and toxicity of this aggressive treatment and some people feel that the procedure isn't warranted."
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