Some of you may already be aware of this, but it was new to me. Apparently, high dose chemotherapy combined with autologous stem cell transplantation has been investigated as a treatment option for breast cancer.
In particular, it's been looked at in at least two contexts. First, as a treatment option if the cancer has spread from the breast to other parts of the body -- that is, for metastatic breast cancer. And, second, as an additional (adjuvant) treatment above and beyond standard first line treatment.
The trials looking into its use have not been particularly positive. This review looked at multiple trials of transplantation for patients with metastatic breast cancer and didn't find much benefit:
http://jco.ascopubs.org/content/29/24/3224.abstract
This review, which is by a similar group of authors, looked at transplantation's use as add-on therapy and found a benefit in progression free survival (they call it relapse-free survival) in higher risk patients, but there was no benefit in overall survival:
http://jco.ascopubs.org/content/29/24/3214.abstract
These reviews apparently are sparking some interest in transplantation as an option for breast cancer patients, however, because most of the studies into the treatment option were done before a number of new, more targeted, therapies for breast cancer were developed.
I'm not sure if this has any major implications for myeloma patients. I just found it interesting and thought I'd share the information with everyone.
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Re: Stem Cell Transplantation for Breast Cancer
OMG!!
I agree Terry, it is interesting...
Unfortunately, this sounds particularly grueling as therapy as well.
Especially since the chemotherapy used in breast cancer is already highly toxic.
I agree Terry, it is interesting...
Unfortunately, this sounds particularly grueling as therapy as well.
Especially since the chemotherapy used in breast cancer is already highly toxic.
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suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
Re: Stem Cell Transplantation for Breast Cancer
Hi suzierose,
I think the reason there is some renewed interest in this approach is that some of the new pharmaceutical treatments for breast cancer are targeted and not as broadly toxic as the regimens that were used in the past.
It's possible, of course, that women considered for this sort of treatment would already have received relatively toxic chemotherapy. But I'm not sure that's the case.
The reason I thought this was interesting is that I always assumed the reason stem cell transplantation was done in multiple myeloma was because it is a blood cancer. The only other cancers I know of where transplantation also is done are lymphoma and leukemia.
I guess, though, that stem cell transplantation can be used more broadly. I'd like to know a bit more about the motivation for using it more broadly.
Is it because oncologists want to use highly toxic chemotherapy to wipe out the cancer cells wherever they might be, and the chemotherapy is so toxic that it also wipes out the bone marrow stem cells, requiring a transplant?
Or is it because the oncologists explicitly want to kill off the bone marrow stem cells, because that's where the residual cancer may be located?
I think the reason there is some renewed interest in this approach is that some of the new pharmaceutical treatments for breast cancer are targeted and not as broadly toxic as the regimens that were used in the past.
It's possible, of course, that women considered for this sort of treatment would already have received relatively toxic chemotherapy. But I'm not sure that's the case.
The reason I thought this was interesting is that I always assumed the reason stem cell transplantation was done in multiple myeloma was because it is a blood cancer. The only other cancers I know of where transplantation also is done are lymphoma and leukemia.
I guess, though, that stem cell transplantation can be used more broadly. I'd like to know a bit more about the motivation for using it more broadly.
Is it because oncologists want to use highly toxic chemotherapy to wipe out the cancer cells wherever they might be, and the chemotherapy is so toxic that it also wipes out the bone marrow stem cells, requiring a transplant?
Or is it because the oncologists explicitly want to kill off the bone marrow stem cells, because that's where the residual cancer may be located?
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TerryH
Re: Stem Cell Transplantation for Breast Cancer
Hi Terry,
I see what you are getting at now. You query:
"Is it because oncologists want to use highly toxic chemotherapy to wipe out the cancer cells wherever they might be, and the chemotherapy is so toxic that it also wipes out the bone marrow stem cells, requiring a transplant?"
IMHO, yes.
I think a lot of times that the use of the word transplant is what makes ASCT appear to be a therapy it is not. The therapy in ASCT is the high dose chemotherapy, NOT the stem cells, which are the same diseased cells the patient had to begin with re-infused. However, if they give the patient the high-dose chemo (mustargen gas) and burn up their marrow, that produces, wbc, rbc, and IG's that carry oxygen to the rest of the body, they will die.
So, what they decided to do was use SALVAGE therapy. They burn up the marrow then they give you your stem cells as salvage therapy to 'rescue' you.
That is the same approach they are using in metastatic breast cancer. They want to give higher doses of chemo than the conventional dose to kill off the tumors that have typically metastasized to the bone. In order, to give the higher dose chemo...they remove the stem cells...give life threatening does of the chemo...then rescue the patient.
HOPING they have killed off more the cancerous cells than the normal ones.
I have not ever agreed with this rationale and find it barbaric. Yet, it is considered as a viable alternative medical therapy despite the majorityof ASCT (50% ) multiple myeloma patients relapsing in 18-36 following the transplant...not to mention..the life long side effects subsequent to the ASCT in survivors...I digress from breast cancer though
Additionally, they have shown longer event free survival in patients without metatastic breast cancer who get high dose chem vs. conventional therapy.
"Compared to conventional chemotherapy, autologous stem cell transplantation can extend "event-free survival" for breast cancer patients. Clinical trials provide proof of this for breast cancer with and without distant metastases. However, there are indications that this type of stem cell transplantation can more frequently give rise to severe complications affecting almost all organ systems. This is the conclusion of the final report of the Institute for Quality and Efficiency in Health Care (IQWiG) published on 16 December 2009."
http://www.news-medical.net/news/20100113/Autologous-stem-cell-transplantation-may-benefit-breast-cancer-patients.aspx
I see what you are getting at now. You query:
"Is it because oncologists want to use highly toxic chemotherapy to wipe out the cancer cells wherever they might be, and the chemotherapy is so toxic that it also wipes out the bone marrow stem cells, requiring a transplant?"
IMHO, yes.
I think a lot of times that the use of the word transplant is what makes ASCT appear to be a therapy it is not. The therapy in ASCT is the high dose chemotherapy, NOT the stem cells, which are the same diseased cells the patient had to begin with re-infused. However, if they give the patient the high-dose chemo (mustargen gas) and burn up their marrow, that produces, wbc, rbc, and IG's that carry oxygen to the rest of the body, they will die.
So, what they decided to do was use SALVAGE therapy. They burn up the marrow then they give you your stem cells as salvage therapy to 'rescue' you.
That is the same approach they are using in metastatic breast cancer. They want to give higher doses of chemo than the conventional dose to kill off the tumors that have typically metastasized to the bone. In order, to give the higher dose chemo...they remove the stem cells...give life threatening does of the chemo...then rescue the patient.
HOPING they have killed off more the cancerous cells than the normal ones.
I have not ever agreed with this rationale and find it barbaric. Yet, it is considered as a viable alternative medical therapy despite the majorityof ASCT (50% ) multiple myeloma patients relapsing in 18-36 following the transplant...not to mention..the life long side effects subsequent to the ASCT in survivors...I digress from breast cancer though
Additionally, they have shown longer event free survival in patients without metatastic breast cancer who get high dose chem vs. conventional therapy.
"Compared to conventional chemotherapy, autologous stem cell transplantation can extend "event-free survival" for breast cancer patients. Clinical trials provide proof of this for breast cancer with and without distant metastases. However, there are indications that this type of stem cell transplantation can more frequently give rise to severe complications affecting almost all organ systems. This is the conclusion of the final report of the Institute for Quality and Efficiency in Health Care (IQWiG) published on 16 December 2009."
http://www.news-medical.net/news/20100113/Autologous-stem-cell-transplantation-may-benefit-breast-cancer-patients.aspx
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suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
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