History: BMT/HDC for Breast Cancer
It is likely that few of you, reading this blog now, remember the era of high dose chemotherapy/stem cell transplants for the treatment of Stage IV or certain high risk early breast cancers. This took place over several years in the 1990s, and came to a disappointing end when it became clear that the outcomes were no better than conventional chemotherapy. Even worse, the risks were clearly much higher, the side effects sometimes horrific (including deaths), and some seemingly positive data from South Africa had been manipulated. For several years, there was very hot politics about this. Because HDC was a big money-maker for hospitals, many community and smaller institutions began to do them. Academic medial centers decried this trend, felt that the necessary safeguards were not always available and that no attention was being made to trials and the advance of research and science. Women with advanced breast cancer, feeling desparate, lobbied insurance companies and legislatures to force them to cover the cost of the treatment--even in the absence of any proof that it worked.
On the other hand, there were always a few women who did remarkably well after these treatments. I personally know two women, with Stage IV breast cancer, who were treated with HDC (high dose chemotherapy) and are alive with no recurrence of their cancer close to twenty years later. The current trend towards more individualized therapy and careful selection of women for particular treatments would have been helpful.
Here is an editorial from the Journal of Clinical Oncology about these treatments. I give you the beginning and then a link:
The Era of High-Dose Chemotherapy for Breast
Cancer: Revisiting a Troubled Quest
Virginia F. Borges and Anthony D. Elias,
University of Colorado School of Medicine, Aurora, CO
Substantial preclinical evaluation of many DNA-damaging agents, particularly alkylating agents, demonstrated steep dose response relationships.
Clinically, these agents caused dose-limiting hematologic toxicity; therefore, to maximize dosages, as justified by mathematical modeling, hematologic progenitor cell support was required. Results in hematologic malignancies such as non-Hodgkin's lymphoma promoted the application of this treatment approach to many solid tumors, including breast cancer. Early phase IIresults were promising; a small subset of the enrolled patients became long-term survivors, and this invoked hope for better outcomes across broader patient cohorts. Ultimately, breast cancer became the predominant indication for high-dose chemotherapy (HDC), which led to the randomized trials that were analyzed by Berry et al.