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FORT LAUDERDALE, Fla., Mar 01, 2001 (United Press International via COMTEX) -- The controversial and expensive "last resort" treatment for women suffering from recurrent breast cancer -- high-dose chemotherapy with bone marrow transplantation -- has been downgraded by doctors writing treatment guidelines for a consortium of the nation's top cancer centers.
"We have taken a step back from our previous guidelines," said Dr. Robert Carlson, chairman of the breast cancer guidelines for the 18-hospital National Comprehensive Cancer Network.
Carlson said Thursday at the NCCN annual meeting in Fort Lauderdale, Fla., that various studies over the past two years had failed to show any survival benefit for people undergoing the grueling procedure.
Although never a full-fledged recommendation by the NCCN, previous guidelines had given some emphasis to getting patients involved in clinical trials of the procedure, explained Carlson, who is also a professor of medicine at Stanford Medical Center in California.
Researchers had suggested the technique offered a way to defeat metastatic breast cancer, or cancer that has advanced to spreading elsewhere in the body. It requires high-dose chemotherapy to wipe out cancer cells -- which also devastates a person's ability to fend off infection -- followed by a bone marrow transplant to restore the fundamental cells that make immunity cells, red blood cells and other critical components.
Dr. Richard Theriault, professor of medicine at the University of Texas MD Anderson Cancer Center, Houston, said that high-dose chemotherapy did not produce worse results in survival, but the expense of the treatment -- well over $100,000 -- and its toxicity mean that its use should be curtailed and probably not used outside a clinical trial.
The breast cancer guidelines have been updated in each of the six years that NCCN committees have been writing them, and Carlson said that in past recommendations doctors were urged to place their patients in clinical trials to evaluate high-dose chemotherapy.
"While we still believe that high-dose chemotherapy and bone marrow transplantation should be evaluated in clinical trials," Carlson said, "we no longer give these clinical trials more weight than any other clinical study. The discussion of high-dose chemotherapy has fallen out of the guidelines."
Carlson added particular cases could arise in which a patient might still be offered the treatment.
However, Theriault suggested that some oncologists were unlikely to even mention the procedure to breast cancer patients because of the lack of effectiveness seen in several clinical trials that were recently completed.
"The evidence we have seen is not compelling," he said. "It doesn't give us a reason to emphasize its use over other clinical trials."
The procedure also suffered a public relations black eye when some positive results were retracted, Carlson said. A South African scientist had reported remarkable success in using the high-dose procedure when compared with standard of care therapy, but subsequent investigations into his studies determined that the results were falsely reported.
The NCCN, which has been writing guidelines for its member institutions and their affiliates since 1996, includes centers such as Stanford, MD Anderson, Memorial Sloan-Kettering Cancer Center in New York, Dana-Farber Cancer Institute in Boston, and the University of Nebraska Medical Center.
By ED SUSMAN, UPI Science News
Copyright 2001 by United Press International.
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