Autologous Bone Marrow Transplantation - Blog Science Connections

Treatment Strategies in Breast Cancer 467
Table 1. Single Agents Useful in Treatment of Breast Cancer
With Bone Marrow Support
Maximum
Organ
Standard-Dose Tolerated Affected
Response Rate Dose by Side
Drug Percentage 8 (mg/m?) Effects
Doxorubicin 35 NA
Nitrogen mustard 35 33 CNS
Cyclophosphamide 34 7,500 Cardiac
Mitolactol C 29 ND
Mitomycin C 24 60 VOD
Methotrexate 23 NA
Streptonigrin 23 ND
Fluorouracil 21 NA
Vindesine 20 ND
Melphalan 19 240 Gl
Altretamine 17 ND
Triethylenethiophosphoramide 17 1,575 Gl, CNS
Carmustine 16 1,000 Hep/pulm
Cisplatin 15 240 Renal
Vincristine 14 NA
Mitoxantrone 13 NA
Abbreviations: NA, not amenable to dose escalation with bone marrow—synergy
with other agents may make use in combination relevant; ND, maximum tolerated
dose with bone marrow support not yet determined; cardiac, hemorrhagic
myopericarditis; Gl, gastrointestinal—enterocolitis, stomatitis; VOD, veno-occlusive
disease; hep, toxic hepatitis; pulm, pulmonary fibrosis.
"Response rates from references 9-11 or pooled from several phase II trials.
alkylating agents (6), the results demonstrated that 1) several alkylating
agents can be combined at full or nearly full doses before dose-limiting major
organ toxicity occurs, although agents cannot be combined with impunity; 2)
the actual toxicities encountered in combination differ from those predicted
for individual agents at high doses (12); and 3) frequent and rapid responses
can occur even in patients with resistant disease. Responses were especially
frequent and rapid in patients with advanced breast cancer, although the
duration of response was in general short.
These results stimulated us to evaluate high-dose combination cyclophosphamide,
cisplatin, and carmustine with ABMS in the treatment of
patients with estrogen receptor-negative, measurable metastatic breast
cancer who had not j»>ceived chemotherapy for metastases. In this review we
compare these treatment results to our current results in patients who were
and were not previously treated with conventional chemotherapy for
advanced breast cancer.