The randomized trials of dose-intensive therapy for breast cancer: what do they mean for patient care and where do we go from here?

At the May 1999 meeting of the American Society of Clinical Oncology (ASCO), results of some of the randomized trials conducted in the 1990's assessing the value of high-dose (dose-intensive) therapy for breast cancer were presented. The number of women treated with such therapy has grown almost exponentially since the early 1990's so that breast cancer is now the most common malignancy treated with stem cell transplant. At the same time the cost of such treatment (from $60,000 upwards to $150,000) has caused it to become the most controversial issue in all of medical oncology during this past decade. Does such therapy truly provide a benefit to women with breast cancer, and is it therefore a therapy that should be routinely offered to suitable patients? This article will attempt to put this issue in some perspective with emphasis on the recently reported randomized studies of this treatment for both early-stage and metastatic disease. In addition, some comments will be made regarding where research regarding this topic will likely be focused in the next few years.