Cisplatin- versus carboplatin-based chemotherapy in first-line treatment of advanced non-small-cell lung cancer: an individual patient data meta-analysis
Abstract
BACKGROUND: Because the efficacy of carboplatin and cisplatin in the treatment of advanced non-small-cell lung cancer (NSCLC) has not been proven to be equivalent, an individual patient data meta-analysis comparing the two treatments was performed. METHODS: Randomized trials comparing carboplatin to cisplatin in first-line treatment of advanced NSCLC were identified and their electronic databases obtained. A general variance-based method was used to estimate the summary hazard ratios (HRs), odds ratios (ORs), and their 95% confidence intervals (CIs) for mortality, objective response, and toxicity. Cochran's chi-square test (Q test) was used to test for heterogeneity among trials, and the I2 index, which expresses the proportion of variability of the results due to heterogeneity, was calculated. A random-effects model that takes into account interstudy variation was also applied. All statistical tests were two-sided. RESULTS: Nine trials that included a total of 2968 patients were analyzed; overall median follow-up was 1021 days. The objective response rate was higher for patients treated with cisplatin than for patients treated with carboplatin (30% versus 24%, respectively; OR = 1.37; 95% CI = 1.16 to 1.61; P<.001). Carboplatin treatment was associated with a non-statistically significant increase in the hazard of mortality relative to treatment with cisplatin (HR = 1.07; 95% CI = 0.99 to 1.15; P = .100). In patients with nonsquamous tumors and those treated with third-generation chemotherapy, carboplatin-based chemotherapy was associated with a statistically significant increase in mortality (HR = 1.12; 95% CI = 1.01 to 1.23 and HR = 1.11; 95% CI = 1.01 to 1.21, respectively). Cisplatin-based chemotherapy was associated with more severe nausea and vomiting and nephrotoxicity; severe thrombocytopenia was more frequent during carboplatin-based chemotherapy. CONCLUSIONS: Our individual patient data meta-analysis suggests that cisplatin-based chemotherapy is slightly superior to carboplatin-based chemotherapy in terms of response rate and, in certain subgroups, in prolonging survival without being associated with an increase in severe toxic effects. Therefore, cisplatin-based third-generation regimens should remain the standard reference for the treatment of selected patients with advanced-stage NSCLC and of those with earlier-stage disease.
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One meta-analysis from individual patient data shows slightly longer overall survival for cisplatin-based versus carboplatin-based doublet in patients with non-squamous NSCLC treated with third-generation regimens.
“One meta-analysis from individual patient data has shown slightly longer OS for cisplatin-based versus carboplatinbased doublet in patients with NSCC and treated with thirdgeneration regimens [I, B] [49].”
From Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up (2016) · cites this paper as [49]
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- Authors
- Ardizzoni, A., Boni, L., Tiseo, M., Fossella, F. V., Schiller, J. H., Paesmans, M., Radosavljevic, D., Paccagnella, A., Zatloukal, P., Mazzanti, P., Bisset, D., & Rosell, R.
- Affiliations
- University of Parma (IT)
- The University of Texas MD Anderson Cancer Center (US)
- Venue
- JNCI Journal of the National Cancer Institute
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-06-05
- Volume
- 99
- Issue
- 11
- Pages
- 847-857
- ISSN
- 0027-8874 (ISSN-L)
- 1460-2105
- OpenAlex
- W2113003672
- Cited by
- 612
- References
- 42
- Citations by year
- 2026: 10 · 2025: 7 · 2024: 15 · 2023: 14 · 2022: 17 · 2021: 12 · 2020: 28 · 2019: 20 · 2018: 32 · 2017: 31 · 2016: 33 · 2015: 40 · 2014: 51 · 2013: 57 · 2012: 56
- FWCI
- 7.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JNCI Journal of the National Cancer Institute (publishedVersion)
- PubMed (publishedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Health Sciences › Medicine › Oncology › Lung Cancer Research Studies
- Keywords
- cisplatin, carboplatin, non-small cell lung cancer, first-line chemotherapy, objective response rate, mortality, chemotherapy toxicity, nephrotoxicity, thrombocytopenia, nausea and vomiting, third-generation chemotherapy, subgroup analysis, treatment effect heterogeneity, random effects models, Cox proportional hazards model
- MeSH terms
- Antineoplastic Agents, Carcinoma, Non-Small-Cell Lung, Cisplatin, Humans, Lung Neoplasms, Survival Rate, Randomized Controlled Trials as Topic, Carboplatin, Treatment Outcome
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