Carboplatin- or cisplatin-based chemotherapy in first-line treatment of small-cell lung cancer: the COCIS meta-analysis of individual patient data

Journal of Clinical Oncology, 04/05/2012

Rossi A et al. – Our meta-analysis of individual patient data suggests no differences in efficacy between cisplatin and carboplatin in the first-line treatment of SCLC, but there are differences in the toxicity profile.

Methods

  • A systematic review identified randomized trials comparing cisplatin with carboplatin in the first-line treatment of SCLC.
  • Individual patient data were obtained from coordinating centers of all eligible trials.
  • The primary end point was overall survival (OS).
  • All statistical analyses were stratified by trial. Secondary end points were progression-free survival (PFS), objective response rate (ORR), and treatment toxicity. OS and PFS curves were compared by using the log-rank test.

Results

  • Four eligible trials with 663 patients (328 assigned to cisplatin and 335 to carboplatin) were included in the analysis.
  • Median OS was 9.6 months for cisplatin and 9.4 months for carboplatin (hazard ratio [HR], 1.08; 95% CI, 0.92 to 1.27; P = .37).
  • There was no evidence of treatment difference between the cisplatin and carboplatin arms according to sex, stage, performance status, or age.
  • Median PFS was 5.5 and 5.3 months for cisplatin and carboplatin, respectively (HR, 1.10; 95% CI, 0.94 to 1.29; P = .25).
  • ORR was 67.1% and 66.0%, respectively (relative risk, 0.98; 95% CI, 0.84 to 1.16; P = .83).
  • Toxicity profile was significantly different for each of the arms: hematologic toxicity was higher with carboplatin, and nonhematologic toxicity was higher with cisplatin.

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