This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nieto, Y. Articles by Jones, R. B. Search for Related Content PubMed PubMed Citation Articles by Nieto, Y. Articles by Jones, R. B.

Long-Term Analysis and Prospective Validation of a Prognostic Model for Patients with High-Risk Primary Breast Cancer Receiving High-Dose Chemotherapy

¹ University of Colorado Bone Marrow Transplant Program, ² Department of Pathology, and ³ Department of Biostatistics, University of Colorado, Denver, Colorado, and ⁴ M.D. Anderson Cancer Center Bone Marrow Transplant Program, Houston, Texas

ABSTRACT

Purpose: We described previously a prognostic model for high-risk primary breast cancer patients receiving high-dose chemotherapy (HDC). Such model included nodal ratio (no. involved nodes:no. dissected nodes), tumor size, hormone receptors, and HER2. In the present study we intended to test this model prospectively in a second patient cohort. In addition, we analyzed the long-term overall outcome of our HDC trials.

Experimental Design: We analyzed all 264 patients enrolled since 1990 in our prospective trials for 4–9+, 10+ nodes, or inflammatory disease. Patients of the second cohort (treated since 1997) had their prognostic score estimated prospectively before receiving HDC.

Results: Fourteen patients (5.3%) died from HDC-related complications. At median follow-up of 7.1 years, relapse-free survival and overall survival of the whole group were 69.8% and 73%, respectively. Median time to relapse was 14 months (63.5% relapses within the first 2 years, 6.7% after year 5). The model was validated in the second cohort, establishing the following pretransplant risk categories: low risk (low score, HER2–), 44% patients, 87% freedom from relapse (FFR); intermediate risk (low score, HER2+), 29% patients, 68% FFR; and high risk (high score, any HER2), 27% patients, 49% FFR.

Conclusions: Few relapses are seen after year 5 of follow-up, which indicates the need for mature results of the randomized trials before their final interpretation or meta-analysis. Our prospectively validated prognostic model, if additionally confirmed in the randomized trial populations, may provide an insight into the relative benefit of HDC in different risk patient subsets.

This article has been cited by other articles:

				O. Gluz, U. A. Nitz, N. Harbeck, E. Ting, R. Kates, A. Herr, W. Lindemann, C. Jackisch, W. E. Berdel, H. Kirchner, et al. Triple-negative high-risk breast cancer derives particular benefit from dose intensification of adjuvant chemotherapy: results of WSG AM-01 trial Ann. Onc., May 1, 2008; 19(5): 861 - 870. [Abstract] [Full Text] [PDF]

				N. Duraker, Z. C. Caynak, and B. Bati Is there any Prognostically Different Subgroup among Patients with Stage IIIC (AnyTN3M0) Breast Carcinoma? Ann. Surg. Oncol., February 1, 2008; 15(2): 430 - 437. [Abstract] [Full Text] [PDF]

				Y. Nieto, F. Nawaz, R. B. Jones, E. J. Shpall, and S. Nawaz Prognostic Significance of Overexpression and Phosphorylation of Epidermal Growth Factor Receptor (EGFR) and the Presence of Truncated EGFRvIII in Locoregionally Advanced Breast Cancer J. Clin. Oncol., October 1, 2007; 25(28): 4405 - 4413. [Abstract] [Full Text] [PDF]

				S. Rodenhuis, M. Bontenbal, Q. G. C. M. van Hoesel, W. M. Smit, M. A. Nooij, E. E. Voest, E. van der Wall, P. Hupperets, H. van Tinteren, J. L. Peterse, et al. Efficacy of high-dose alkylating chemotherapy in HER2/neu-negative breast cancer Ann. Onc., April 1, 2006; 17(4): 588 - 596. [Abstract] [Full Text] [PDF]

				Y. Nieto, E. J. Shpall, I. K. McNiece, S. Nawaz, J. Beaudet, S. Rosinski, J. Pellom, V. Slat-Vasquez, P. A. McSweeney, S. I. Bearman, et al. Prognostic Analysis of Early Lymphocyte Recovery in Patients with Advanced Breast Cancer Receiving High-Dose Chemotherapy with an Autologous Hematopoietic Progenitor Cell Transplant Clin. Cancer Res., August 1, 2004; 10(15): 5076 - 5086. [Abstract] [Full Text] [PDF]