Dose-intensive chemotherapy for locally advanced breast cancer.

The availability of hematopoietic growth factors has allowed a range of feasibility and uncontrolled studies with high-dose chemotherapy (with or without stem-cell support) to take place. Preliminary data from some randomized studies are now available as well. Dose-intensive chemotherapy appears to be effective in downstaging the tumor. Only a minority of patients achieve a pathologic complete remission and additional therapeutic options to control minimal residual disease are urgently needed. There are few indications that high-dose chemotherapy is superior to conventional dose therapy in terms of relapse-free or overall survival. Although the results of most randomized studies are premature or unknown at this time, a modest but clinically significant survival advantage may still emerge.