Lung cancer is the leading cause of cancer death and almost 75% of people are incurable at diagnosis. Non-small cell is the most common type of lung cancer (almost 90% of all lung cancer cases). For many of these people, chemotherapy is a good treatment option and it is associated with longer survival and better quality of life. However, treatment for people with advanced non-small cell lung cancer is palliative, in that it provides relief from pain and other distressing symptoms. Treatments that include cisplatin or carboplatin plus another drug are the most widely used drug combinations, but they can be associated with undesirable toxicity. Thus, it would be desirable to have a treatment that is just as effective but with less toxicity.
We found 10 trials (including 5017 people) that compared cisplatin with carboplatin, both combined with another modern drug, called a third-generation drug. The drugs were equally effective at prolonging survival, but the toxicity profile was different. Cisplatin caused more nausea or vomiting or both and carboplatin caused more numbness and tingling in hands and feet and greater decrease in the number of platelets (which control clotting) in the blood.
Unfortunately, we could not analyse quality of life in our review because only two trials studied this and they used different methods to measure the effects.
The initial treatment of people with advanced NSCLC is palliative, and carboplatin can be a treatment option. It has a similar effect on survival but a different toxicity profile when compared with cisplatin. Therefore, the choice of the platin compound should take into account the expected toxicity profile and the person's comorbidities. In addition, when used with either paclitaxel or gemcitabine, the drugs had an equivalent response rate.
An estimated 220,000 new cases of non-small cell lung cancer (NSCLC) and 160,000 deaths are expected to occur in the US in 2013, representing about 28% of cancer-related mortality. Approximately 75% of these people will have locally advanced or metastatic disease and will be treated in a palliative setting. Platinum-based combination chemotherapy has benefits in terms of survival and symptom control when compared with best supportive care.
To assess the efficacy and safety of carboplatin-based chemotherapy when compared with cisplatin-based chemotherapy, both in combination with a third-generation drug, in people with advanced NSCLC. To compare quality of life in people with advanced NSCLC receiving chemotherapy with cisplatin and carboplatin combined with a third-generation drug.
We searched the following electronic databases: MEDLINE (via PubMed) (1966 to 6 March 2013), EMBASE (via Ovid) (1974 to 6 March 2013), Cochrane Central Register of Controlled Trials (CENTRAL; Issue 2, 2013), and LILACS (1982 to 6 March 2013). In addition, we handsearched the proceedings of the American Society of Clinical Oncology Meetings (January 1990 to March 2013), reference lists from relevant resources and the Clinical Trial.gov database.
Randomised clinical trials comparing regimens with carboplatin or cisplatin combined with a third-generation drug in people with locally advanced or metastatic NSCLC. We accepted any regimen and number of cycles that included these drugs, since there is no widely accepted standard regimen.
Two review authors independently assessed search results and a third review author resolved any disagreements. We analysed the following endpoints: overall survival, one-year survival, quality of life, toxicity and response rate.
We included 10 trials with 5017 people, 3973 of whom were available for meta-analysis. There was no difference between carboplatin-based and cisplatin-based chemotherapy in overall survival (hazard ratio (HR) 1.00; 95% confidence interval (CI) 0.51 to 1.97, I2 =0%) and one-year survival rate (risk ratio (RR) 0.98; 95% CI 0.88 to 1.09, I2 =24%). Cisplatin had higher response rates when we performed an overall analysis (RR 0.88; 95% CI 0.79 to 0.99, I2 = 3%), but trials using paclitaxel or gemcitabine plus a platin in both arms had equivalent response rates (paclitaxel: RR 0.89; 95% CI 0.74 to 1.07, I2 = 0%; gemcitabine: RR 0.92; 95% CI 0.73 to 1.16, I2 = 34%). Cisplatin caused more nausea or vomiting, or both (RR 0.46; 95% CI 0.32 to 0.67, I2 = 53%) and carboplatin caused more thrombocytopenia (RR 2.00; 95% CI 1.37 to 2.91, I2 = 21%) and neurotoxicity (RR 1.55; 95% CI 1.06 to 2.27, I2 = 0%). There was no difference in the incidence of grade III/IV anaemia (RR 1.06; 95% CI 0.79 to 1.43, I2 = 20%), neutropenia (RR 0.96; 95% CI 0.85 to 1.08, I2 = 49%), alopecia (RR 1.11; 95% CI 0.73 to 1.68, I2 = 0%) or renal toxicity (RR 0.52; 95% CI 0.19 to 1.45, I2 = 3%). Two trials performed a quality of life analysis; however, they used different methods of measurement so we could not perform a meta-analysis.