In people with advanced non-small cell lung cancer, combined with other medications, carboplatin and cisplatin do not differ for overall or 1-year survival

de Castria TB, da Silva EMK, Gois AFT, et al.. Cisplatin versus carboplatin in combination with third-generation drugs for advanced non-small cell lung cancer. Cochrane Database Syst Rev. 2013:8:CD009256.

Review question

How effective and safe is carboplatin compared with cisplatin in people with advanced non-small cell lung cancer?

Background

2 major types of lung cancer are small cell lung cancer  and non-small cell lung cancer. About 85 to 90% of lung cancers are non-small cell lung cancer.

Newer anticancer medications with different action mechanisms (third-generation drugs) are available. These medications—in combination with cisplatin—are standard chemotherapy for advanced non-small cell lung cancer. However, carboplatin chemotherapy may have a different toxicity profile.

The aim of treatment for people with advanced non-small cell lung cancer is only to provide relief from pain and distress.

How the review was done

This systematic review included 10 randomized controlled trials of 5,017 people aged 18 to 75 years with advanced non-small cell lung cancer. The publication period was 2001 to 2011.

Carboplatin was compared with cisplatin—both in combination with a third-generation drug (gemcitabine, paclitaxel, or docetaxel).

Outcomes were overall survival, 1-year survival rate, quality of life, and toxic effects.

What the researchers found

Overall survival

• Carboplatin and cisplatin—both in combination with a third-generation drug—did not differ in overall survival.

1-year survival

• Carboplatin and cisplatin—both in combination with a third-generation drug—did not differ in 1-year survival.

Drug toxicities

• Cisplatin caused about 2.3 times more nausea or vomiting events, or both, than carboplatin.
• Carboplatin caused about 2 times more low platelet count events (which can cause bleeding) than cisplatin.
• Carboplatin caused about 1.5 times more nerve toxicity events (which cause numbness or pain) than cisplatin.
• Carboplatin and cisplatin did not differ for anemia, skin rash, white blood cell deficiency, hair loss, or kidney toxicity.

Conclusions

In people with advanced non-small cell lung cancer, combined with a third-generation drug, carboplatin and cisplatin do not differ for overall and 1-year survival.

Cisplatin causes more nausea or vomiting. Carboplatin causes more low-platelet count and nerve toxicity events.