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.
Most clinicians in North America prefer carboplatin to cisplatin because it has fewer side effects and is easier to administer. 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, because both drugs had side effect. Carboplatin was more likely to decrease blood platelet levels, while cisplatin was more likely to cause nausea, vomiting, and damage to the kidneys.
Christopher and colleagues 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 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 wrote.