Peters W P, Dansey R D, Klein J L, Baynes R D
Bone Marrow Transplant Program, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan 48201, USA.
Oncologist. 2000;5(1):1-13. doi: 10.1634/theoncologist.5-1-1.
Each year in the USA, 180,000 new cases of breast cancer are diagnosed and about 44,000 women die of the disease. Current primary treatment consists of adjuvant chemotherapy and hormone therapy, and statistics show that combination chemotherapy favorably influences the outcomes in both node-negative and node-positive primary disease. However, a significant number of breast cancer patients succumb to the disease, and nearly every patient diagnosed with metastatic breast cancer will be dead within five years. High-dose chemotherapy (HDC) and peripheral blood progenitor cell transplantation (PBPCT) are based upon laboratory and clinical observations of the ability to modify growth properties of quiescent and replicating cancer cells. A large number of HDC and PBPCT regimens have been evaluated for treatment of metastatic breast cancer, and recent autologous bone marrow transplantation data indicate that three HDC regimens (CPB, CTCb and cytoxan and thiotepa) predominate. Unfortunately, negative media coverage surrounding and subsequent to the presentation of preliminary findings reported at the May 1999 American Society of Clinical Oncologists, that were not allowed adequate follow-up time for full analysis of treatment results, has had a detrimental effect on the ability to conduct trials in this area. Several randomized trials have been conducted in both the metastatic and high risk primary disease settings. Thorough analysis of these studies indicates an evaluable improvement in favor of HDC and PBPCT in three of the four randomized studies performed in metastatic breast cancer and two of the four high risk primary studies. Also, initial evaluations found that quality of life appeared comparable in patients receiving either HDC or not. Each randomized trial studied asks a different question and, depending on the intensity of HDC regimen, the intensity and duration of the standard dose chemotherapy control and the schedule of events in relation to induction chemotherapy, the outcomes may be quite variable. Still, certain general trends are indentifiable. HDC alone will not completely cure breast cancer and should be considered as part of an overall therapeutic plan. In some of these studies, significantly longer follow-up is required before definitive analysis can be completed.
在美国，每年有18万例新发乳腺癌病例被诊断出来，约4.4万名女性死于该病。目前的主要治疗方法包括辅助化疗和激素治疗，统计数据表明，联合化疗对淋巴结阴性和淋巴结阳性的原发性疾病的治疗效果均有积极影响。然而，仍有相当数量的乳腺癌患者死于该病，几乎每一位被诊断为转移性乳腺癌的患者都会在五年内死亡。大剂量化疗（HDC）和外周血祖细胞移植（PBPCT）是基于对静止和增殖癌细胞生长特性进行调控的实验室及临床观察结果。大量的HDC和PBPCT方案已被评估用于治疗转移性乳腺癌，近期的自体骨髓移植数据表明，三种HDC方案（环磷酰胺、卡铂和噻替派联合；环磷酰胺、噻替派和卡铂联合；环磷酰胺和噻替派）最为常用。不幸的是，1999年5月美国临床肿瘤学会公布初步研究结果后，媒体的负面报道以及后续报道没有给予足够的随访时间来全面分析治疗结果，这对该领域开展试验的能力产生了不利影响。在转移性和高危原发性疾病方面都进行了几项随机试验。对这些研究的全面分析表明，在转移性乳腺癌的四项随机研究中有三项以及高危原发性疾病的四项研究中有两项显示，HDC和PBPCT有明显的可评估的改善。此外，初步评估发现，接受HDC或未接受HDC的患者生活质量似乎相当。每项随机试验研究的问题都不同，而且根据HDC方案的强度、标准剂量化疗对照的强度和持续时间以及与诱导化疗相关的事件安排，结果可能会有很大差异。不过，仍可确定某些总体趋势。单独使用HDC并不能完全治愈乳腺癌，应将其视为整体治疗方案的一部分。在其中一些研究中，需要更长时间的随访才能完成最终分析。
