Meta-Analysis Suggests Cisplatin Superior to Carboplatin for Advanced NSCLC
Adapted from the NCI Cancer Bulletin.
Cisplatin is likely a better option than carboplatin for patients with advanced-stage non-small-cell lung cancer (NSCLC), according to a meta-analysis of nine randomized clinical trials comparing the two drugs.
The analysis, which involved data on nearly 3,000 individual patients, revealed a superior response rate in patients with NSCLC treated with a cisplatin-based chemotherapy regimen compared with carboplatin-based regimens, and a small but statistically significant improvement in overall survival in patients with nonsquamous NSCLC and those in whom cisplatin was combined with so-called third-generation chemotherapy drugs, such as gemcitabine, paclitaxel, and docetaxel.
"The superiority of cisplatin over carboplatin was not achieved at the cost of a statistically significant increase in the incidence of severe side effects," wrote lead author Dr. Andrea Ardizzoni, of University Hospital in Parma, Italy, and colleagues in the June 6, 2007, Journal of the National Cancer Institute (see the journal abstract). They reported that, while cisplatin-based regimens were associated with a greater incidence of high-grade nausea, vomiting, and kidney problems, carboplatin was associated with more drastic drops in platelet counts (thrombocytopenia).
Based on clinical trial results, the two drugs have been considered to be equally effective in treating advanced NSCLC, and U.S. oncologists have favored carboplatin because it has been associated with fewer side effects and is easier to administer.
In an accompanying editorial, Dr. Christopher G. Azzoli, from Memorial Sloan-Kettering Cancer Center, and colleagues noted that more effective antinausea medications could help to decrease cisplatin's toxicity burden. They also cited cisplatin's increased effectiveness in patients with nonsquamous disease, which they argued was particularly important given the success seen in a recent U.S. phase III study in the same patient population treated with a combination of the targeted agent bevacizumab and carboplatin and paclitaxel (see the related story).
Overall, the editorial states, "the apparent superiority of cisplatin over carboplatin…should not be taken lightly, particularly in patients being treated with a curative intent."
Meanwhile, a European phase III trial presented at the ASCO annual meeting (see the abstract) found that combining bevacizumab with cisplatin and gemcitabine provides a slight improvement - less than a month - in median progression-free survival compared with chemotherapy alone.