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High Dose Cyclophosphamide, Thiotepa, and Carboplatin followed by Autologous Peripheral Stem Cell Rescue in Patients with Responsive Metastatic or High - Risk Primary Breast Cancer
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Se Haeng Cho, Sang Hee Kim, Young Joo Min, Sung Joon Choi, Jung Kyun Kim, Tae Won Kim, Jong Soo Choi, Dai Young Zang, Je Hwan Lee, Sung Bae Kim, Cheol Won Suh, Kyoo Hyung Lee, Jung Shin Lee, Woo Kun Kim, Se Hyun Ahn, Jung Mi Park, Sang We Kim
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J Korean Cancer Assoc. 1998;30(1):100-105.
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 Abstract
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- PURPOSE
Positive correlation between dosage of antineoplastic agents and tumor response is well demonstrated in advanced breast cancer. But severe bone marrow depression limit the clinical application of high dose chemotherapy. Autologous peripheral blood stem cell transplantation(PBSCT) after high dose chemotherapy(HDC) was introduced to promote rapid bone marrow recovery. This study was designed to establish the feasibility of combining high dose cyclophosphamide, thiotepa, and carboplatin chemotherapy followed by stem cell rescue in patients with responsive metastatic or high risk primary breast cancer.
MATERIALS AND METHOD
Eligibility criteria included the presence of high risk primary breast cancer(10 or more involved axillary lymph node, n=4), recurrent disease after curative resection(n=6) or stage IV disease at the time of diagnosis(n=1). The responses of recurrent disease to initial chemotherapy were 4 complete responses and 1 partial responses. One recurrent case with solitary pulmonary metastasis underwent metastasectomy and got chemotherapy after operation. Colony stimulating factor was administered to mobilize stem cells from bone marrow to peripheral blood.
The stem cell collection was performed 4~10 times(median 4) and the number of collected stem cell was 1.95~7.34x10(8)kg(median 4.87x10(8)/kg). High dose chemotherapy with CTCb (cyclophosphamide 1,500 mg/m2/day, thiotepa 125 mg/m2/day, carboplatin 200 mg/m2/ day) was performed from day -7 to day -4 and peripheral stem cell infusion was performed on day 0 as planned.
RESULT
Eleven patients were enrolled in this study. Their median age was 39 years old. The median time for bone marrow recovery was 11 days for neutrophil(>500/mm2) and 28 days for platelet(>50,000/mm2). Packed red blood cell and platelet transfusion were performed in 11 patients. The group whose infused mononuclear cell count was less than 4.0 x 10(8)/kg(n=9) needed longer time for bone marrow recovery than those(n=2) who had more than 4.0 x 10(8)/kg( 20 vs 13 day, p < 0.05 ). For non-hematologic toxicity, none have experienced toxicity more than grade III. There were 2 recurrences of 4 cases with high risk breast cancer at the 22 th, and 25 th month but they are still alive at the 28 th, and 29 th month each. The other 2 cases are alive without recurrences at the 18 th, and 20 th months each. In the recurrent disease group, one case who showed partial response to initial chemotherapy recurred at the 4 th month and died at the 13 th month after PBSCT. The other 5 cases are alive without recurrence at the 1st, 3 rd, 3 rd, 5 th, and 31 th month each. One case with stage IV disease(bone metastasis) is alive without evidence of progression at the 3 rd month.
CONCLUSION
High dose chemotherapy with PBSCT can be performed safely. Long term survival of patients with advanced breast cancer would be possible by PBSCT after HDC.
Further clinical trials based on larger patient population is required to evaluate clinical efficacy of PBSCT after HDC in high risk and recurrent breast cancer.
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Adjuvant Chemotherapy with ' 5-Fluorouracil Plus Low - dose Leucovorin Following Surgical Resection of Stage 2 , 3 Colon Cancer
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Je Hwan Lee, Tae Won Kim, Jong Soo Choi, Dai Young Zang, Ho Young Pyun, Sung Bae Kim, Sang We Kim, Cheol Won Suh, Kyoo Hyung Lee, Jung Shin Lee, Woo Kun Kim, Sang Hee Kim, Jin Cheon Kim, Suk Koo Kim
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J Korean Cancer Assoc. 1995;27(5):846-857.
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Abstract
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- Obtivea: About seventy-five percent of the individuals with colon cancer will have a primary surgical resection with the hope of complete tumor eradication. Despite the high resectability rate and a general improvement in therapy, nearly half of all patients with colon cancer still die of metastatic tumor. Over the past three decades, many clinical studies have failed to demonstrate benefits from adjuvant therapy. Recently, new data from several studies have demonstrated delays in tumor recurrence and increases in survival for specific groups of patients. The objective of this study was to evaluate the effective- ness of 5-fluorouracil(5-FU) and low-dose leucovorin in reducing the recurrence rate and improving the survival of the patients with surgically resected colon cancer in stage II and III. Methods: One hundred and fifty six with surgically resected colon cancer in stage II and 1II from Nov 1989 to Dec 1993 were included in this study and were divided into two groups. First group(LF arm) included eighty five Patients who received combination chemotherapy of '5-FU and low-dose 1eucovorin' following resection of colon cancer, and second group(control arm) included seventy one patients who received only oral UFT or no adjuvant treatment. '5-FU and low-dose leucovorin' chemotherapy consisted of leucovorin 20 mg/m(2), intravenously, plus 5-FU 400 mg/m(2), intravenously, on days 1-5 every 4 weeks for 6 cycles. Results: I) There were significantly more recurrences and distant failure in control arm than LF arm. 2) The estimated 4-year disease-free survival was 82.5% in LF arm and 59.8% in control arm(p = 0.007). 3) The estimated 4-year overall survival was 94.3% in LF arm and 63.9% in control arm (p = 0.001). 4) The survival differences between LF arm and control arm were significant in stage II and III respectively. 5) Number of metastatic lymph nodes, histologic differentiation, and whether or not pa- tients received 5-FU/leucovorin chemotherapy, were each found to have prognostic significance. Concluslon: This study strongly suggests that 5-FU and low-dose leucovorin adjuvant chemotherapy is effective in patients with surgically resected stage II and III colon cancer.
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KCA
