There is no evidence to support the use of high dose chemotherapy over standard regimens in breast cancer treatment, say researchers in the Netherlands.

Some reports have suggested that high dose chemotherapy may reduce the high recurrence rate of breast cancer, and many centres offer this routinely. But at the Netherlands Cancer Institute in Amsterdam, 81 premenopausal women with stable, node positive breast cancer were studied. All underwent standard treatment, which involved three cycles of pre surgical chemotherapy, as well as the drugs cyclophosphamide, epirubicin and fluorouracil weekly for three weeks.

The women were randomised into two post surgery groups: conventional chemotherapy and two years of tamoxifen; or further high dose chemotherapy plus tamoxifen.

At follow up at 72 months, there were no differences between the two groups for overall survival or a disease free state. Furthermore, all the women in the high dose group became irreversibly infertile.

The results suggest that high dose regimens should be considered experimental. According to the authors they should be reserved, if used at all, for the setting of a randomised clinical trial (Lancet, 1998; 352: 515-21).