Four trials of high-dose chemotherapy with stem cell support in breast cancer in the adjuvant and metastatic settings have shown no long-term disease-free or overall survival gain. This relative failure of a single high-dose therapy we believe opens up the development of a dose-dense approach with block scheduling as the most promising way forward. This intensive chemotherapy can be more easily combined with the newer biological therapies and our prediction is that this will prove to be the most effective treatment in the future for women with poor risk breast cancer.