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Study Raises Questions on Transplant Timing

Study Raises Questions on Transplant Timing

ASCO--Immediate high-dose consolidation chemotherapy supported
by transplant significantly improved disease-free survival in
metastatic breast cancer patients who were in complete remission
after induction therapy.

However, overall survival was significantly better in the complete
responders who received transplant only at the time of relapse,
suggesting that the timing of transplant in these patients may
be important, William P. Peters, MD, PhD, said at an ASCO scientific
session.

The results represent an 8-year effort by a group at Duke University
led by Dr. Peters who is now chief and CEO of the Karmanos Cancer
Institute, Detroit.

This trial enrolled 423 patients with hormone-insensitive metastatic
breast cancer who were treated with up to four cycles of an intensive
doxorubicin-based regimen. Patients who achieved complete remission
were randomized to immediate consolidation with high-dose cyclophosphamide/platinum/carmustine
and transplant or to observation. Patients in the observation
arm who relapsed were given the same high-dose regimen with transplant.
Partial responders were treated with immediate transplant.

The patients tended to be young, with a median age of 42 years.
No prior chemotherapy for metastatic disease was allowed, although
adjuvant chemotherapy was permitted. Patients could have no more
than three involved sites on bone scan.

Dr. Peters noted that the data are mature, with a median follow-up
of 4.7 years for the complete remission patients and 3.5 years
for the partial responders.

Of the 105 patients who achieved a complete remission, seven were
not randomized, in four cases because the insurance company refused
to pay, he said.

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