ABSTRACT
High-dose chemotherapy continues to be an experimental and somewhat controversial treatment modality. In the past few years, its administration in conjunction with peripheral blood progenitor cell (PBPC) transplantation has become reasonably safe, although it clearly remains more toxic than conventional dose therapy. It has been shown to improve both the objective remission rate and progression-free survival in stage IV breast cancer, but very few randomized trials of high-dose therapy in breast cancer have shown an overall survival benefit. It is possible that high-dose therapy, which usually employs alkylating chemotherapy, may be specifically effective in HER2/neunegative disease, whereas HER2/neu-positive disease requires the use of anthracyclines and taxanes, which are less suitable for high-dose chemotherapy regimens. The coming years should clarify these issues further and modern techniques such as microarray gene expression analysis may become useful for selecting patients and tumors for this intensive treatment strategy.
