HIGH-DOSE CARBOPLATIN, THIOTEPA AND CYCLOPHOSPHAMIDE (CTC) WITH PERIPHERAL-BLOOD STEM-CELL SUPPORT IN THE ADJUVANT THERAPY OF HIGH-RISK BREAST-CANCER - A PRACTICAL APPROACH

In 29 chemotherapy-naive patients with stage II-III breast cancer, peripheral blood stem cells (PBSCs) were mobilised following fluorouracil 500 mg m(-2), epirubicin 90-120 mg m(-2) and cyclophosphamide 500 mg m(-2) (FEC) and granulocyte colony-stimulating factor (G-CSF; Filgrastim) 300 mu g s.c. daily. In all but one patient, mobilisation was successful, requiring three or fewer leucocytopheresis sessions in 26 patients; 28 patients subsequently underwent high-dose chemotherapy consisting of carboplatin 1600 mg m(-2), thiotepa 480 mg m(-2) and cyclophosphamide 6 g m(-2) (CTC) followed by PBSC transplantation. Haemopoietic engraftment was rapid with a median time to neutrophils of 500 x 10(6) 1(-1) of 9 days (range 8-10) in patients who received G-CSF after PBSC-transplantation; platelet transfusion independence was reached within a median of 10 days (range 7-16). Neutropenic fever occurred in 96% of patients. Gastrointestinal toxicity was substantial but reversible. Renal, neural or ototoxicity was not observed. Complications related to the central venous catheter were encountered in 64% of patients, with major vein thrombosis occurring in 18%. High-dose CTC-chemotherapy with PBSC-transplantation, harvested after mobilisation with FEC and C-CSF, is reasonably well tolerated without life-threatening toxicity and is a suitable high-dose strategy for the adjuvant treatment of breast cancer.