High-Dose Chemotherapy of Cyclophosphamide, Thiotepa, and Carboplatin (CTCb) with Autologous Peripheral Blood Stem Cell Transplantation for High-Risk Primary Breast Cancer and Metastatic Breast Cancer

Min, Young Joo; Suh, Cheol Won; Lee, Je Hwan; Chae, Young Ran; Kim, Shin; Bae, Chang Whang; Park, Jin Hee; Choi, Sung Joon; Kim, Tae Won; Yoon, Whan Jung; Jung, Byung Hak; Zang, Dai Young; Choi, Jong Soo; Kim, Sung Bae; Kim, Sang We; Lee, Kyoo Hyung; Lee, Jung Shin; Kim, Woo Kun; Ahn, Sei Hyun; Park, Jung Mi; Kim, Sang Hee

Abstract

OBJECTIVES
Recently high dose chemotherapy with autologous peripheral blood stem cell transplantation (APBSCT) has been investigated with the hope of maximizing tumor response and increasing survival. The purpose of this study is to evaluate the effect, feasibility, and toxicity of high-dose cyclophosphamide, thiotepa, and carboplatin (CTCb) with APBSCT in patients with metastatic or high risk primary breast cancer.
METHODS
Four cases of high-risk primary breast cancer (with more than 10 involved axillary nodes) and three cases of metastatic disease in complete or partial response were enrolled. Peripheral blood stem cells were mobilized by G-CSF plus chemotherapy, and median number of collected mononuclear cells was 5.44 X 108/kg(range, 1.95-7.08 X 108/kg). High-dose chemotherapy of cyclophosphamide (1,500mg/m2/day), thiotepa (125mg/m2/day) and carboplatin (200mg/m2/day) was administered for 4 days and peripheral blood stem cells were reinfused to the patients 72 hours after the completion of chemotherapy.
RESULTS
The median days of recovery for neutrophil (over 500/mm3) and for platelet (over 50,000/mm3) were 10 (range, 8 to 33) and 30 (range, 10 to 40). One patient suffered from seizure attack and grade 3 hepatotoxicity during high dose chemotherapy, There were no treatment-related death. Four patients with high-risk primary breast cancer remained disease-free at 2, 8, 12 and 19 months post-transplant. In one patient with bone metastasis, complete response was induced following APBSCT. All three patients with metastatic disease remained progression-free at 8, 18 and 19 months post-transplant.
CONCLUSION
High-dose chemotherapy and autologous peripheral blood stem cell transplantation was feasible and would be a potentially effective treatment modality in high risk and metastatic breast cancer.