[Autologous stem cell transplantation for breast cancer]

IQWiG
Record ID 32010000663
English
Authors' objectives: The aims of this investigation were to assess studies on certain types of autologous stem cell transplantation in breast cancer patients: compared to cytostatic therapy without stem cell support, and compared with each other. The focus was on patient-relevant outcomes.
Authors' recomendations: In the case of non-metastatic breast cancer – i.e. there are no distant metastases - there is proof of a benefit of single autologous SCT compared to conventional chemotherapy at 5-years' disease-free survival or a comparable outcome. However, there is also an indication of harm due to the occurrence of severe, life-threatening complications. This indication of harm can also be applied to the comparison with dose-dense chemotherapy. In the case of tandem autologous SCT when compared to conventional-dose chemotherapy, neither proof nor indications of benefit or harm can be derived for the outcomes assessed in this report. In contrast, if tandem autologous SCT is compared with dose-dense chemotherapy, there is an indication of benefit for the outcomes "overall survival" and "event-free survival". However, this indication is limited to the therapy regimen in the WSG AM-01 trial, from which this benefit was derived. It must be noted that, with the exception of 1 trial, anthracycline-based chemotherapy was used in the control treatment of all trials included in the benefit assessment. Nowadays, a taxane-based chemotherapy protocol is generally recommended for patients with non-metastatic, nodal-positive breast cancer. In the case of metastatic breast cancer, there is proof of a benefit of single autologous SCT compared to conventional-dose chemotherapy for "disease-free survival" or a comparable outcome. In contrast, there is an indication of harm due to the occurrence of severe, life-threatening complications. In the case of tandem autologous SCT when compared to conventional-dose chemotherapy, there is also an indication of harm due to the occurrence of severe, life-threatening complications. No proof or indication of benefit can be derived for tandem autologous SCT for any of the outcomes assessed in this report. It cannot be excluded that individual subgroups of patients with breast cancer benefit from autologous SCT. However, subgroup analyses were only carried out in a few trials on selected patient collectives, and the statistical significance of the subgroup differences remains unclear. Consequently, no proof or indication of benefit can be derived. For patients with metastatic breast cancer in particular, for whom there are still no curative treatment options, it is necessary to provide alternative treatment approaches while taking account of patient preferences and possibly in combination with autologous SCT. As the initial introduction of autologous SCT into health care was based on uncertain data, other therapy approaches should only be evaluated within controlled trials.
Details
Project Status: Completed
Year Published: 2009
URL for additional information: http://www.iqwig.de/index.598.en.html
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Germany
MeSH Terms
  • Stem Cell Transplantation
  • Transplantation, Autologous
Contact
Organisation Name: Institute for Quality and Efficiency in Health Care (IQWiG)
Contact Address: IQWiG, Im Mediapark, 8, DE-50670 Cologne, GERMANY, Tel: +49(0)221-35685, Fax: +49(0)221-356851
Contact Email: berichte@iqwig.de
Copyright: Institut fuer Qualitaet und Wirtschaftlichkeit im Gesundheitswesen (IQWiG)
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