The Pharmaceutical Journal
Vol 269 No 7219 p517
12 October 2002

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Annals of Oncology (annonc.oupjournals.org)

Cisplatin-based chemotherapy should be first-line treatment for lung cancer

Patients with lung cancer who are treated with cisplatin and paclitaxel have better survival rates than patients treated with carboplatin and paclitaxel, results of a European trial suggest. And, because carboplatin-based therapy offers no advantage in terms of tolerance or quality of life, cisplatin-based chemotherapy should be the first treatment option, the investigators say (Annals of Oncology 2002;13:1539).

Dr Rafael Rosell, from the Hospital Germans Trias i Pujol in Barcelona, and colleagues randomised 618 patients with advanced non-small-cell lung cancer (NSCLC) to receive one of two treatments (see Panel). They found that response rates for the two groups were similar — 28 per cent in the cisplatin/paclitaxel group and 25 per cent in the carboplatin/paclitaxel group (P=0.45) — but that the group of patients treated with cisplatin had a better median survival (9.8 months compared with 8.5 months). The one-year survival rate was 38 per cent in the cisplatin/paclitaxel group compared with 33 per cent in the carboplatin/paclitaxel group and the two-year survival rates were 15 per cent and 9 per cent, respectively.

Dr Rosell said: "This large European randomised study can contribute greatly to resolving the long-standing debate on the superiority of carboplatin- or cisplatin-based chemotherapy in lung cancer. Although paclitaxel/carboplatin yielded a similar response rate, the significantly longer median survival obtained with paclitaxel/cisplatin indicates that cisplatin-based chemotherapy should be the first treatment option." However, the researchers stress that paclitaxel/carboplatin is still a viable alternative "with a similar response rate, a good safety profile, manageable toxicity and superior ease of administration".

The researchers point out that cisplatin tends to be the preferred standard chemotherapy for lung cancer in Europe, but that in the US carboplatin is normally used. They also comment that their findings need to be treated with caution because previous studies have shown no survival benefit for cisplatin over carboplatin.

In an accompanying editorial (ibid, p1515), Dr Thierry Le Chevalier of the Institut Gustave Roussy, France, says differences between the findings of European and US trials could be related to differences in dosage and the infusion time of the cisplatin combination or possible differences in population characteristics.

However, he concludes that if NSCLC survival is to improve new approaches to treatment are needed. "We have reached the therapeutic ceiling in NSCLC with standard chemotherapy whether it is cisplatin based or not," he adds.