Two of the most common chemotherapy regimens may be comparable in terms of efficacy when used in combination with radiotherapy for treatment of non-small cell lung cancer (NSCLC), according to a recent study published in JAMA Oncology.
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Carboplatin-paclitaxel and cisplatin-etoposide regimens are commonly used concurrently with thoracic radiation for patients with unresectable NSCLC. However, there have not been any prospective studies to date that compare the efficacy or toxicity of the two regimens.
Researchers led by Conor E Steuer, MD, Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University (Atlanta, GA), conducted a systemic review of published trials to determine the most effective chemotherapy regimen to be given concurrently with radiation for stage III NSCLC. Efficacy was determined by comparing median overall survival (OS), progression-free survival (PFS), response rate, and toxic effects between patients who received the two regimens plus radiation. A total of 79 studies were examined, which included 3090 patients from 31 studies who received cisplatin-etoposide treatment (median age, 61 years; median radiation dose, 63.0 Gy) and 3728 patients from 48 studies who received carboplatin-paclitaxel treatment (median age, 63 years; median radiation dose, 64.6 Gy).
Results of the study showed no clinically significant difference in median PFS (12 months vs 9.3 months; P = .20), median OS (19.6 months vs 18.4 months; P = .40), or median 3-year survival rate (31% vs 25%; P = .50) between the cisplatin-etoposide and carboplatin-paclitaxel groups. There was also no significant difference in response rates between the two groups (58% vs 56%, respectively; P = .26).
However, rates of adverse events differed between the groups. Cisplatin-etoposide was associated with higher rates of grade 3 to 4 hematological effects (neutropenia, 54% vs 23%; P < .001) and grade 3 to 4 nausea and vomiting (20% vs 11%; P = .03) than carboplatin-paclitaxel.
Researchers concluded that cisplatin-etoposide and carboplatin-paclitaxel regimens are comparable in efficacy when used with concurrent radiotherapy for patients with stage III unresectable NSCLC. However, the toxic-effect profile favors a carboplatin-paclitaxel regimen. Further research is needed to validate these findings.
