Breast Cancer Treatment: Will HDCT make a return?

A few of you may remember the time when some breast cancer patients, those with Stage IV disease or very aggressive new breast cancers, were sometimes treated with high-dose chemotherapy (HDCT). Sometimes referred to as transplants, these treatments involved multi-week hospitalizations, very high doses of chemotherapy, and then an infusion of the patient's own stem cells to make recovery possible.

This treatment was used from 1993-1999 and ended when it was discovered that some data indicating the very best results had been fabricated. This scandal, coming from South African studies, was devastating and effectively ended the program around the world. The toxicity from HDCT was very high, and, overall, the results were no better for these women than for those who were treated with standard chemotherapies.

There was a tantalizing footnote: Some women were cured by this treatment. I knew two: one a woman who underwent high-dose chemotherapy for Stage IV breast cancer and a second who had the treatment for a very aggressive, newly-diagnosed Stage III breast cancer. All these years later, they are both well and have never had a recurrence.

It turns out that many others were also interested in this subset of women, and there is now a report from the Netherlands that young women with Stage III disease or high-risk of triple negative breast cancers may benefit from HDCT. The secondary analysis of the results of the trials from the 1990s found a survival rate of 44.5% for this subset of women with Stage III breast cancer vs. 29.5% of women who were treated with standard care.

Reviewers of this report gave it the highest possible grade, meaning that it showed a clinically significant benefit. In a parallel and unexpected finding, HDCT was also associated with improved overall survival in the subgroup of women who had triple negative breast cancers. For them, 52.9% were alive 20 years later vs. 37.5% who had received conventional chemotherapy.

Stepping back, many doctors have expressed some warnings about these results. High-dose chemotherapy is intense and highly toxic. Although there have been real advances in the care of people undergoing these therapies (which are commonly used for other kinds of cancer, primarily leukemia and lymphoma), it is a daunting process.

There are always some people who fall on the positive end of the bell curve and do much better than anticipated. What is different here is the suggestion that there are specific subgroups of women with breast cancer who might benefit from a second look at this treatment option. To be continued…

Read more about BIDMC's Young Women's Breast Cancer Program.