High-dose chemotherapy as adjuvant treatment for high-risk breast cancer has been and is being investigated in a series of randomized trials. The preliminary information from 5 studies is difficult to interpret. The data are consistent with a modest benefit of high-dose therapy, but strong evidence for this is lacking. Additional follow-up and the results of several large trials outside the United States are awaited. Hitherto unrecognized pharmacologic interactions between high-dose agents and long-term toxicities such as cognitive function impairment complicate the issue considerably.
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