June 6, 2007 Some patients with advanced non--small-cell lung cancer (NSCLC) have slightly higher survival rates when treated with the chemotherapy drug cisplatin than another platinum-based drug, carboplatin, according to a study in the June 6 Journal of the National Cancer Institute. The authors conclude that cisplatin chemotherapy should remain the standard of care for these patients.
Recent randomized studies have shown that the addition of platinum-based drugs to standard chemotherapy improves patient outcomes. Based on this data, new guidelines for treating advanced NSCLC recommend platinum-based chemotherapy as the standard of care. Most clinicians in North America prefer carboplatin to cisplatin because it has fewer side effects and is easier to administer. Nonetheless, it was unclear whether the drugs are equally effective in NSCLC patients.
Andrea Ardizzoni, M.D., of University Hospital in Parma, Italy, and colleagues conducted a review of nine randomized trials comparing the survival of 2,968 NSCLC patients who received either cisplatin- or carboplatin-based chemotherapy.
Patients who received cisplatin lived slightly longer than those treated with carboplatin, with a median survival of 9.1 months compared with 8.4 months. The difference in survival was not statistically significant, except in patients treated with more recent chemotherapy combinations and those with nonsquamous-cell tumors. Both drugs had side effects. Carboplatin was more likely to decrease blood platelet levels, while cisplatin was more likely to cause nausea, vomiting, and damage to the kidneys.
"Given the palliative nature of chemotherapy treatment in advanced NSCLC and the unquestionable practical advantage of carboplatin in terms of ease of administration, it could be argued that the small benefit achieved with cisplatin relative to carboplatin does not justify its preferential use in clinical practice. However, all the progress in the treatment of advanced NSCLC has been made in small increments," the authors write.
In an accompanying editorial, Christopher Azzoli, M.D., and colleagues at the Memorial Sloan-Kettering Cancer Center in New York discuss the renewed rivalry between cisplatin and carboplatin, particularly in the face of new developments in adjuvant chemotherapy for NSCLC patients. "The apparent superiority of cisplatin over carboplatin demonstrated in this paper should not be taken lightly, particularly in patients being treated with curative intent. Equally inadvisable would be the overzealous use of cisplatin in patients with metastatic NSCLC for whom the drug may be poorly tolerated, such as those with significant baseline renal impairment, hearing loss, peripheral neuropathy, or other serious medical comorbidities," the authors write.
Article: Ardizzoni A, Boni L, Tiseo M, Fossella FV, Schiller JH, et al. Cisplatin- Versus Carboplatin-Based Chemotherapy in First-Line Treatment of Advanced Non -- Small-Cell Lung Cancer: An Individual Patient Data Meta-analysis. J Natl Cancer Inst 2007; 99: 847-857
Editorial: Azzoli CG, Kris MG, Pfister DG. Cisplatin Versus Carboplatin for Patients With Metastatic Non -- Small-Cell Lung Cancer -- An Old Rivalry Renewed. J Natl Cancer Inst 2007; 99: 828-829
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