The efficacy and safety of high-dose adjuvant chemotherapy with paxlitaxel and thiotepa in postoperative breast cancer patients with high risk of recurrence

Objective: Patients with high-risk breast cancer has a high recurrence rate. The clinical value of high-dose adjuvant chemotherapy supported by autologous HSCT (hematopoietic stem cell transplantation) for postoperative breast cancer patients with high risk of recurrence remains controversial. This study was to explore the efficacy and safety of high-dose adjuvant chemotherapy with paxlitaxel and thiotepa supported by autologous HSCT for postoperative breast cancer patients with high risk of recurrence. Methods: Twenty-four postoperative breast cancer patients (stages  Ⅱ-Ⅲ) with high risk of recurrence were enrolled in this study. The patients received paclitaxel 175 mg/m2 and G-CSF (granulocyte colony-stimulating factor) 5 μg/kg for mobilization and collection of peripheral blood CD34+ stem cells. Then two cycles of high-dose adjuvant chemotherapy were given subsequently [11 patients: paclitaxel 175 mg/m2 + thiotepa 150 mg/m2 + carboplatin (area under curve = 6; 300 mg/m2 divided in two days); 13 patients: paclitaxel 175 mg/m2 + thiotepa 150 mg/m2) every 28 d]. The CD34+ stem cells were infused for an autologous HSCT on day 2 after chemotherapy, and the G-CSF was started on day 3 after chemotherapy and discontinued until the peripheral WBC (white blood cell) count reached over 10.0×109/L continuously for three days. The adverse effects of high-dose adjuvant chemotherapy were observed. The median DFS (disease-free survival) and the three-year DFS rate were calculated. Results: The median follow-up was 32 months (3-62 months). The median DFS was 32 ​​months. The three-year DFS rate was 56.3%. High-dose chemotherapy had a good safety profile and no treatment-related death. Conclusion: High-dose chemotherapy with paclitaxel and thiotepa supported by autologous HSCT in postoperative breast cancer patients with high risk of recurrence has a good safety profile and can obtain a better benefit of DFS as compared with standard-dose chemotherapy. These results suggest that this treatment strategy deserves further exploration. DOI:10.3781/j.issn.1000-7431.2013.04.007