Dose-intensification chemotherapy for patients with advanced breast cancer

It is now possible to administer doses of chemotherapy several-fold those used in standard treatment regimens. This can be done with relative safety, and in patients with metastatic breast cancer or refractory non-Hodgkin's lymphoma such treatment produces a high complete-remission rate. Some patients enjoy a longterm disease-free survival following dose-intensive therapy. Chemotherapy intensified to this degree produces prolonged periods of myelosuppression. This can be managed rather well with progenitor-cell infusion and cytokine support. There is little experience with such regimens in the treatment of locally advanced or locally aggressive breast cancer. However, early experience in several institutions, including our own is encouraging. In this article the rationale for dose intensity, the experience in metastatic breast cancer, and the available information on outcomes in locally advanced cancer are reviewed. The appropriate role for dose-intensive chemotherapy in locally advanced breast cancer treatment remains to be defined.