Non-small Cell Lung Cancer: Cisplatin-etoposide vs Carboplatin-paclitaxel

A recent review suggests that cisplatin-etoposide and carboplatin-paclitaxel regimens are comparable in efficacy when used with concurrent definitive radiotherapy for the treatment of non-small cell lung cancer (NSCLC). The carboplatin-paclitaxel regimen was, however, associated with fewer toxic side effects.¹

The review included 31 studies of 3090 patients treated with cisplatin-etoposide and 48 studies of 3728 patients treated with carboplatin-paclitaxel. The authors found no significant differences in response rates (58% for cisplatin-etoposide and 56% for carboplatin-paclitaxel); the same was true for progression free survival (12 months vs 9.3 months) and overall survival (19.6 months vs 18.4 months).

“Given that carboplatin and paclitaxel is the most commonly used regimen in the United States, our study provides further justification for this approach in stage III NSCLC management,” said study author Suresh Ramalingam, MD, professor of hematology and medical oncology at Emory University’s School of Medicine in Atlanta, Georgia.

Dr Ramalingam and colleagues found that cisplatin-etoposide was associated with higher grade 3 to 4 hematological toxic effects compared with carboplatin-paclitaxel. The rates of neutropenia were more than double (54% vs 23%) and the grade 3 to 4 nausea/vomiting were almost double (20% vs 11%).

“Cisplatin-based regimens are best reserved for younger patients and those with minimal co-morbid conditions, given the higher degree of toxicities associated with it,” Dr Ramalingam told Cancer Therapy Advisor. “Treatment should be individualized to the patients based on performance status, age, and renal function.”