"Ten years ago, if a woman didn't get a bone marrow transplant, people were suing HMOS, because they said they were denying care," Brooks said. "The cases won."
Although progressively easier to tolerate, the therapy often caused nausea, vomiting, extreme weakness and infection. Some patients even died from the treatment.
Some small studies found that the treatment was beneficial for women with very high-risk cancer (at least 10 positive lymph nodes), but the trials were not randomized.
Later, randomized trials did not confirm the same benefit, and the treatment has largely fallen out of favor.
"But there were still some nagging questions," Berry said. "One was that maybe there was a subset who benefited."
Berry and his colleagues reviewed 15 randomized studies of high-dose chemotherapy conducted around the world between 1988 and 2002. Together, the trials involved more than 6,000 patients with a median follow-up of seven years.
There was a 13 percent decrease in the rate of breast cancer relapse in patients receiving high-dose chemotherapy. But that benefit did not extend survival. The decrease in mortality was only 6 percent, which was not statistically significant.
Increasing doses of chemotherapy do have some benefit for breast cancer patients, but it does reach a point of diminishing returns.
"Increasing the dose is good, but it reaches a plateau," confirmed Berry.
The American Cancer Society has more on chemotherapy for breast cancer.
SOURCES: Donald Berry, Ph.D., professor and head, Division of Quantitative Sciences, University of Texas M.D. Anderson Cancer Center, Houston; Jay Brooks, M.D., chai
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