For the last few years, what was a well established dictum in breast cancer chemotherapy circles, viz. that there was a dose response relationship for the efficacy of chemotherapy in this disease, has been used to fuel trials in high dose chemotherapy in breast cancer.
These trials have been reported recently. Unfortunately and unexpectedly, they have almost uniformly been negative; that is to say that the patients who received high dose chemotherapy in addition to standard chemotherapy fared no better than the patients who received standard chemotherapy alone. This applied to the high risk adjuvant trial patients and those with established metastatic disease. The subject of high dose chemotherapy and bone marrow auto-transplantation or peripheral stem cell rescue has gone onto the ‘back burners’ of clinicians’ algorithms of best care, at least for the time being.