High-dose chemotherapy in breast cancer -- the perils of history uncontrolled.

Breast cancer remains a common and devastating disease that affects approximately 180,000 women and results in more than 43,000 deaths annually in the United States. Although only 10% of patients have overt metastatic disease at the time of diagnosis, as many as one third of those who present with lymph node-negative disease and half of those who present with lymph node-positive disease eventually develop metastatic breast cancer. With few exceptions, metastatic breast cancer is largely incurable, and the median duration of survival remains 18 to 24 months. Over the past 3 decades, both laboratory and clinical efforts to increase survival have focused on dose intensity in chemotherapy regimens.