Advanced or 'metastatic' breast cancer is cancer that has spread beyond the breast and underarm lymph nodes to other parts of the body. Although metastatic breast cancer is often responsive to conventional chemotherapy it does not provide a cure. The dose of chemotherapy that can be given to an individual is limited because it is unsafe in high doses and can seriously damage the bone marrow, creating high risk of serious infection. One treatment that was considered promising at the start of the 1990's was use of autograft, which involves transplantation of a woman's own bone marrow or peripheral stem cells to regenerate her bone marrow. Autografting allowed the administration of chemotherapy doses many times higher than could otherwise be used. This systematic review aimed to compare the evidence from randomised controlled trials comparing high dose chemotherapy with conventional chemotherapy.
This review identified six randomised trials including 437 women receiving high dose chemotherapy with autograft and 413 women receiving conventional chemotherapy treatment. In the group receiving the high dose chemotherapy, there were 15 treatment-related deaths as opposed to two in the conventional chemotherapy arm. Although the high-dose treatment did not increase overall survival at 5 years compared with conventional treatment, women on the high-dose treatment survived significantly longer before experiencing recurrence of cancer. Treatment side-effects were worse in the high-dose group. On the basis of this review, the authors conclude that high dose chemotherapy with bone marrow or stem cell transplantation should not be given to women with metastatic breast cancer outside of clinical trials.