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October 13, 1999

High-Dose Chemotherapy and Breast Cancer

Author Affiliations

Author Affiliations: Breast Medical Oncology, Lynn Sage Breast Cancer Program, Robert H. Lurie Comprehensive Cancer Center, and Division of Hematology/Oncology, Northwestern University Medical School, Chicago, Ill.

JAMA. 1999;282(14):1378-1380. doi:10.1001/jama.282.14.1378

The rapid transfer of medical technology from academic research institutions into the medical community at large is perhaps not better exemplified than with the widespread use of high-dose chemotherapy (HDC) and peripheral blood stem cell transplantation (PBSCT) as treatments for breast cancer during the late 1980s and the 1990s.1 With better supportive care measures, particularly use of hematopoietic growth factors, morbidity and mortality due to HDC administration dramatically declined, and the length of hospital stays needed for patients to recover from treatment effects decreased significantly.1 Peripheral blood stem cells proved to be more reliable and "patient-friendly" in ensuring engraftment, compared with autologous bone marrow.1 Subsequent data from pilot or feasibility trials in patients with metastatic disease showed that HDC-PBSCT improved tumor response rates compared with conventional-dose chemotherapy.2 Many medical oncologists, patients, and advocates were quick to assume that HDC-PBSCT was superior to other therapies used to treat metastatic breast cancer.

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