WHAT WAS LEARNED


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Differences in the overall response rate (ORR) between the nedaplatin arm (62.73%) and the cisplatin arm (54.13%) were not significant. There also were no significant differences between the two arms when the investigators assessed MPE treatment efficacy in patients with lung cancer, breast cancer, or gastrointestinal cancer. What did stand out, however, was that nedaplatin was associated with significantly lower rates of GI side effects and significantly less incidence of increased serum creatinine levels in comparison with cisplatin. The overall rate of toxicity in the nedaplatin arm was 40%, which was almost half of what turned up in the cisplatin arm (78.9%).

“This is a practically useful study that may lead to the use of nedaplatin over cisplatin due to lower systemic toxicity of nedaplatin,” said Michael K. Gibson, MD, PhD, associate professor of medicine and physician with Vanderbilt-Ingram Cancer Center, Nashville, Tennessee. “This is a medium sized (219 patient) retrospective study that compares the risks and benefits of intra-pleural nedaplatin vs cisplatin for treatment of malignant pleural effusions from various cancers, mostly, breast, lung, and GI. This approach is not common in the United States, but it seems to be in Asia.”

IMPLICATIONS FOR NURSES

The findings suggest that nedaplatin is superior to cisplatin in terms of toxicity in the treatment of MPE.  However, this investigation is limited by its retrospective nature.  In addition, the authors note that the patient selection and treatment assignments might be affected by confounding factors.  Other limitations of the study are its relatively small sample size and a lack of patient survival data.

A significant issue with this patient population is quality of life.  So, limiting adverse side effects is paramount. Nedaplatin has the same therapeutic mechanisms as cisplatin. However, the authors note that it is 10 times more water-soluble than cisplatin. Due to its lower GI side effects and renal toxicity, it is being used increasingly in chemotherapy. The authors caution that these results need further confirmation with well-designed prospective studies.

“There is a need for more effective approaches to treat malignant pleural effusions, given their significant impact on quality of life and survival. The approach outlined in this study is one option,” Dr Gibson told Oncology Nurse Advisor. “The most important findings is that while the 2 drugs have similar efficacy, nedaplatin has fewer side effects.”

Reference

Zhong LZ, Xu HY, Zhao ZM, Zhang GM, Lin FW. Comparison of efficacy and toxicity between nedaplatin and cisplatin in treating malignant pleural effusion. Onco Targets Ther. 2018;11:5509–5512.