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31Jan 2020

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High-dose chemotherapy in high-risk breast cancer shows improved survival in 20-year follow-up

The N4+ study was conducted at ten centres in the Netherlands by Prof. Sjoerd Rodenhuis (Netherlands Cancer Institute) and Prof. Liesbeth de Vries (UMCG) from 1993 to 1999. The study investigated the effectiveness of high-dose chemotherapy compared with conventional dose chemotherapy in 885 women with breast cancer and at least four positive lymph nodes in the armpit.

To allow the blood count to recover after high-dose chemotherapy the treatment was combined with an autologous stem cell transplant, where the patients' own stem cells were used.


Tessa Steenbruggen says: "The 20-year follow-up shows a significant improvement in survival after high-dose chemotherapy in patients with ten or more affected lymph nodes in the armpit and a strong indication of improved survival in patients with triple negative breast cancer. Unfortunately, the latter group is slightly too small to draw definite conclusions, but it is certainly impressive that 15% more women have survived 20 years after high-dose chemotherapy than after conventional dose chemotherapy."

Side effects

Furthermore, the incidence of secondary cancers or serious cardiovascular diseases does not appear to increase after high-dose chemotherapy. These are the feared side effects of administering high-dose chemotherapy. The data underlines the importance of further research on high-dose chemotherapy in patients with high-risk (stage 3) breast cancer, such as the Dutch SUBITO study currently being conducted.

National register

Thanks to the excellent documentation of the study together with the cancer register and PALGA pathology database, almost complete data is available for a period of 20 years. Lars Steggink says: "These national records offer a unique opportunity to collect the long-running follow-up data of patients, which is vital to the continued improvement of our breast cancer care".

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