Non-small cell lung cancer (NSCLC)
is not a small problem. Of the estimated 21,700 new cases
of lung cancer in Canada each year, 80% turn out to be
NSCLC. Moreover, lung cancer is the leading cause of cancer-related
death in Canada. So, developments on the treatment front
are of course eagerly awaited. A paper published in the
October 1 issue of the Journal of Clinical Oncology
reported that a cisplatin-based therapy along with chemo
may increase the survival of those with advanced NSCLC,
as compared to treatment involving carboplatin. However,
this increase comes at the expense of more side effects.
"Our results show that cisplatin-based
chemotherapy yielded significant, but only modest survival
advantage," commented lead author Dr Katsuyuki Hotta
of Okayama University Medical School, Japan. "On the
other hand, regarding subjective toxicity (ie nausea
and vomiting), we demonstrated that carboplatin-based
chemotherapy was milder than cisplatin-based chemotherapy."
Time
to go PLATINUM
Dr Hotta and his colleagues reached this conclusion
following a meta-analysis of clinical trials that compared
the outcome of the two treatment strategies in advanced
cases of NSCLC. They identified eight trials involving
2,948 patients, five of which looked at the effectiveness
of treatment with the platinum-containing compounds
cisplatin or carboplatin alone or in combination with
a new compound (irinotecan, vinorelbine, gem-citabine,
paclitaxel or docetaxel).
Analysis of survival data from
2,903 patients revealed that treatment with cisplatin
produced 5% better overall survival than that produced
by carboplatin-based therapy. Further, when the combination
treatments were looked at, the combo of cisplatin and
a new agent produced 11% longer survival as compared
with carboplatin plus a new agent.
The new agents, looked at individually,
all produced similar results. So, the differences noted
were presumably due to the platinum compound.
Both drugs produced side effects.
Nausea and vomiting occurred nearly three times more
often in patients receiving cisplatin. Those receiving
carboplatin were more likely to experience a drop in
the numbers of platelets in their blood.
Finally, while more patients receiving
cisplatin died, the treatment-related mortality was
not significantly different from the number of carboplatin
treatment-related deaths. The results led the researchers
to cautiously conclude "that cisplatin has a possible
advantage in the treatment of advanced NSCLC compared
with carboplatin, if cisplatin is combined with a new
agent." The researchers said that their results "raise
a critical point" but stressed that "the strength of
our conclusion is limited because we used abstracted
data."
For now, Dr Hotta recommends that
the choice of cisplatin is made only after a physician
has weighed the good and bad aspects of the treatment
with each individual patient.
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