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Indian Journal of Cancer, Vol. 48, No. 4, October-December, 2011, pp. 452-453 Lung - Editorial Can Carboplatin replace Cisplatin in small cell lung cancer? V Noronha Consultant Surgical Oncologist, Tata Memorial Hospital, Parel, Mumbai, India Code Number: cn11124 PMID: 22293259 In the recent past, our understanding of non-small cell lung cancer (NSCLC) has significantly expanded in terms of molecular pathogenesis, new targets and improved therapies. Small cell lung cancer unfortunately remains as much a mystery as it was about 30 years ago, without significant advances in our understanding of the disease biology. However, we have learned better ways of administering old chemotherapy, to enhance acceptability and decrease toxicity. We welcome the article from Turkey in this issue of the IJC which highlights current epidemiological data on NSCLC from India and an article from Turkey describing a non-Cisplatin regimen for the first-line therapy of extensive stage small cell lung cancer. In 1979, Sierocki first reported on the remarkable activity of a combination of Cisplatin and Etoposide in patients with small cell lung cancer. [1] In 1985, Evans et al. confirmed that this is an active regimen with a complete remission rate of 43% and an additional 43% of the patients had a partial remission. The median survival of patients with extensive disease who demonstrated a response to Cisplatin/Etoposide was 9.5 months. [2] This regimen has gone on to become the standard first-line therapy in patients with small cell lung cancer, both for extensive stage disease and for limited stage. However, Cisplatin is problematic in terms of emetogenicity, nephrotoxocity, ototoxicity, dyselectrolytemia and the need for significant amount of accompanying hydration. Several studies have examined if Carboplatin may be substituted for Cisplatin, without significantly compromising the efficacy. In 1987, Smith et al. from the Royal Marsden reported that the combination of Carboplatin and Etoposide is effective with a response rate of 88% (13% complete remission rate) in extensive disease. [3] Okamoto et al. reported that Carboplatin AUC 5 with Etoposide 80 mg/m 2 daily for 3 days was equivalent to split doses of Cisplatin 25 mg/m 2 and Etoposide 80 mg/m 2 , both given daily for 3 days. There was no difference in the response rate, median survival or toxicity, except for thrombocytopenia which was higher in the Carboplatin-based regimen. [4] In this issue of the IJC, Yilmaz et al. add another study to the body of evidence supporting the use of Carboplatin in this patient population. The group from Turkey treated 88 patients having extensive stage small cell lung cancer with six cycles of Carboplatin AUC 6 on day 1 and Etoposide 100 mg/m 2 for 3 days. Little over half of the patients completed six courses of chemotherapy. The objective response rate was 70% with 24% complete response (CR), 46% partial response (PR) and 8% stable disease. The median progression-free survival (PFS) was 7.2 months and the overall median survival was 9 months. Hematological toxicity was substantial, with almost 60% of patients experiencing grade 3 or 4 neutropenia and 14% of patients developing febrile neutropenia. 16% of the patients developed grade 3 or 4 thrombocytopenia. Non-hematologic toxicity was insignificant. There were no toxic deaths. Although this was not a randomized trial, results appear to be comparable to the earlier studies in the literature, both for Carboplatin-based regimens as well as Cisplatin-based regimens. Should we therefore routinely use the combination of Carboplatin with Etoposide as first-line therapy in extensive stage small cell carcinoma? The answer is a guarded yes. One must be watchful for hematologic toxicity and manage it appropriately, with a low threshold for the use of growth factors. The bottom line is that a Carboplatin-based regimen may be administered more easily, with equivalent survival results and palliation. References
Copyright 2011 - Indian Journal of Cancer |
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