Cisplatin-etoposide and carboplatin-paclitaxel regimens have comparable efficacy when used with concurrent definitive radiotherapy for patients with stage III unresectable non-small cell lung cancer (NSCLC), but carboplatin-paclitaxel is associated with a more favorable safety profile, according to a study published in JAMA Oncology.1
Carboplatin-paclitaxel and cisplatin-etoposide are the 2 most frequently used chemotherapy regimens administered concurrently with thoracic radiation for patients with unresectable IIIA and IIIB NSCLC; however, no prospective studies have compared the efficacy of these 2 regimens.
Therefore, researchers sought to conduct a systematic review of studies that have assessed outcomes and toxicities of carboplatin-paclitaxel and cisplatin-etoposide with concurrent radiation treatment.
For the study, investigators analyzed data from 3090 patients with stage III disease who received cisplatin plus etoposide included in 31 studies and 3728 patients who received carboplatin plus paclitaxel from 48 studies.
Median radiation dose 63.0 Gy in the cisplatin-etoposide group and 64.6 Gy in the carboplatin-paclitaxel group. Forty percent of patients had squamous histology in each group.
Results showed that 58% of patients treated with cisplatin plus etoposide achieved a response compared with 56% of those who received carboplatin plus paclitaxel (P = .26).
There were also no significant difference in median progression free survival (P = .20), overall survival (P = .40), or 3-year survival rate (P = .50) between the 2 groups.
Although rates of grade 3 to 4 pneumonitis (P = .12) and esophagitis (P = .27) were similar between cisplatin-etoposide and carboplatin-paclitaxel, researchers found that cisplatin-etoposide was associated with a significantly higher incidence of grade 3 to 4 hematologic toxicities (P < .001) and nausea/vomiting (P = .03) compared with carboplatin-paclitaxel.
Steuer CE, Behera M, Ernani V, et al. Comparison of concurrent use of thoracic radiation with either carboplatin-paclitaxel or cisplatin-etoposide for patients with stage III non–small-cell lung cancer. JAMA Oncol. 2016 Dec 15. doi: 2016 Dec 15. [Epub ahead of print]