Highhyphen;dose chemotherapy is increasingly utilized for the treatment of metastatic and highhyphen;risk breast cancer. Autologous Blood and Marrow Transplant Registry data reveal that a single highhyphen;dose cycle of chemotherapy with stem cell support can produce high complete response rates, with 10percnt; to 20percnt; of patients diseasehyphen;free at 5 years. For patients with locally advanced disease, pooled results estimate 63percnt; without relapse at 3 years for stage II and III disease and 42percnt; for inflammatory breast cancer. New strategies to improve on these results include the incorporation of newly identified active drugs into established regimens and the use of multiple highhyphen;dose cycles. Multicycle chemotherapy produces complete response rates ranging from 35percnt; to 93percnt; depending on the regimen. Additional strategies include the use of monoclonal antibodies, immunotherapy, and gene therapy for posthyphen;transplant consolidation. The strongest predictor of longterm diseasehyphen;free survival in virtually all studies is a complete response prior to or following highhyphen;dose chemotherapy. Randomized studies are now in the process of being completed in Europe and the United States with reporting scheduled over the next several years.
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