Meta-Analysis of Randomized Clinical Trials Comparing Cisplatin to Carboplatin in Patients With Advanced Non–Small-Cell Lung Cancer

Hotta, Katsuyuki; Matsuo, Keitaro; Ueoka, Hiroshi; Kiura, Katsuyuki; Tabata, Masahiro; Tanimoto, Mitsune

doi:10.1200/jco.2004.02.109

Cited by 340 publications

(216 citation statements)

References 23 publications

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“…The high downstaging rate and the absence of treatment-related death in our CRS arm translated into a longer median OS (39.6 months) and higher 3-year survival rate (51.7%). Choi et al 9 conducted a phase 2 study of an induction treatment involving twice-daily radiation and concurrent chemotherapy in 42 patients with stage IIIA NSCLC, and reported that the 5-year survival rate in patients with pathological complete response (79%) was significantly higher (P ¼ .04) than that in patients with pN1 (42%) or pN2 20 Induction chemotherapy or chemoradiotherapy in our present trial was well tolerated by patients in both arms, with excellent treatment compliance. No grade 3/4 fever was found in either arm, despite the high incidence of grade 3/4 neutropenia (75% in the CS arm, 89.3% in the CRS arm), nor was any grade 3/4 radiation esophagitis observed in the CRS arm.…”

Section: Discussionmentioning

confidence: 99%

A phase 3 study of induction treatment with concurrent chemoradiotherapy versus chemotherapy before surgery in patients with pathologically confirmed N2 stage IIIA nonsmall cell lung cancer (WJTOG9903)

Katakami

Tada

Mitsudomi

et al. 2012

Cancer

109

107

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BACKGROUND: This study sought to ascertain whether induction-concurrent radiotherapy added to chemotherapy could improve the survival of patients undergoing surgery for stage IIIA N2 nonsmall cell lung cancer (NSCLC). METHODS: Patients with pathologically proven N2 disease were randomized to receive either induction chemotherapy (docetaxel 60 mg/m 2 and carboplatin AUC [area under the receiver operating characteristic curve] ¼ 5 for 2 cycles) plus concurrent radiation therapy (40 Gy) followed by surgery (CRS arm) or induction chemotherapy followed by surgery (CS arm). They subsequently underwent pulmonary resection when possible. RESULTS: Sixty patients were randomly assigned between December 2000 and August 2005. The study was prematurely terminated in January 2006 because of slow accrual. The most common toxicity was grade 3 or 4 leukopenia in 92.9% of patients in the CRS arm and 46.4% in the CS arm. Induction therapy was generally well tolerated, and there were no treatment-related deaths in either arm. Downstaging in the CS arm and CRS arm was 21% and 40%, respectively. The progression-free survival (PFS) and overall survival (OS) in the CS arm were 9.7 months and 29.9 months (PFS, hazard ratio [HR] ¼ 0.68, P ¼ .187), and those in the CRS arm were 12.4 months and 39.6 months (OS, HR ¼ 0.77, P ¼ .397), respectively. The PFS with and without downstaging was 55.0 and 9.4 months, respectively (HR ¼ 3.39, P ¼ .001). The OS with and without downstaging was 63.3 and 29.5 months, respectively (HR ¼ 2.62, P ¼ .021). CONCLUSIONS: The addition of radiotherapy to induction chemotherapy conferred better local control without significant adverse events. Tumor downstaging is important for prolonging the OS in patients with stage IIIA (N2) NSCLC. Cancer 2012;118:6126-35.

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Section: Discussionmentioning

confidence: 99%

A phase 3 study of induction treatment with concurrent chemoradiotherapy versus chemotherapy before surgery in patients with pathologically confirmed N2 stage IIIA nonsmall cell lung cancer (WJTOG9903)

Katakami

Tada

Mitsudomi

et al. 2012

Cancer

109

107

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“…Recent large randomized trials of cisplatin/etoposide with or without newer cytotoxic agents have demonstrated a MST of 8.0 -10.6 months in previously untreated patients with ED-SCLC (De Marinis et al, 2003, Georgoulias et al, 2004Niell et al, 2005). In addition, a recent meta-analysis of randomized trials demonstrated that patients who received a regimen containing cisplatin had a significant increase in the probability of response and survival (Pujol et al, 2000;Hotta et al, 2004). Thus, we consider irinotecan/carboplatin of value as a convenient carboplatin-containing two-drugs regimen with similar activity to cisplatin-containing regimens, except irinotecan/cisplatin in patients with ED-SCLC.…”

Section: Discussionmentioning

confidence: 99%

Phase II study of irinotecan combined with carboplatin in previously untreated small-cell lung cancer

et al. 2006

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To determine the efficacy and toxicity of irinotecan combined with carboplatin, we conducted a phase II trial. Eligibility criteria were: chemotherapy-naïve, small-cell lung cancer (SCLC), good performance status (PS: 0 -2), agep75 years, and adequate organ function. The patients' characteristics were: male/female ¼ 56/5; PS 0/1/2 ¼ 19/38/4; median age (range) ¼ 68 years(51 -75 years); limited disease (LD)/extensive disease (ED) ¼ 27/34. The patients received irinotecan (50 mg m À2 ) on days 1, 8, and 15, and carboplatin (AUC 5, Chatelut formula) on day 1 every 4 weeks. In total, 61 patients were eligible and all were evaluated. In all, 31 patients were treated with four or more courses of chemotherapy. Of the patients, 17 showed a complete response (CR), 34 showed a partial response (PR), nine had stable disease (SD), and one had progressive disease (PD). The overall response rate was 84% (95% confidence interval (CI), 72 -91%; LD 89%, ED 79%) and the CR rate was 28% (95%CI, 17 -41%; LD 37%, ED 21%). The median time to tumour progression was 6.1 (LD 6.4, ED 5.4) months. The medial survival time was 15.0 (LD 20.0, ED 9.7) months, and the 2-year and 5-year survival rates were 31.1% (LD 48.1%, ED 17.7%) and 9.5% (LD 11.1%, ED 5.9%), respectively. Grade 3 or 4 leucopenia, neutropenia, thrombocytopenia, anaemia, and diarrhoea occurred in 33, 74, 41, 39, and 13% of cases, respectively. In conclusion, the combination of irinotecan and carboplatin is an active and well-tolerated regimen in cases of SCLC.

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“…Thus, the introduction of carboplatin into Phase III trials also may have contributed to improved treatment outcomes over the years, especially in the late period of this study. The survival prolongation observed with the use of carboplatin, however, seemed to be shorter than that observed with the use of cisplatin, as observed in several randomized Phase III trials of cisplatin/carboplatin and in a recent meta-analysis 6,17,18 ; the TAX326 study, 1 of these large Phase III trials, indicated a trend toward improved survival in the docetaxel plus cisplatin arm compared with the docetaxel plus carboplatin arm, although that trial was designed to compare the 2 docetaxel arms not with each other but with the comparator vinorelbine plus cisplatin arm.…”

Section: Discussionmentioning

confidence: 93%

Recent improvement in the survival of patients with advanced nonsmall cell lung cancer enrolled in phase III trials of first‐line, systemic chemotherapy

Hotta¹,

Fujiwara²,

Matsuo³

et al. 2007

Cancer

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BACKGROUND.Few studies have assessed formally whether treatment outcomes have improved substantially over the years for patients with advanced nonsmall cell lung cancer (NSCLC) enrolled in Phase III trials. The objective of the current investigation was to determine the time trends in outcomes for the patients in those trials.METHODS.The literature was searched to identify trials that addressed the role of chemotherapy regimens in the first‐line setting for the treatment of advanced NSCLC. Trends were tested by using multiple regression analysis.RESULTS.In total, 121 Phase III trials were identified that involved 42,768 patients with 263 chemotherapy arms and 11 best supportive care (BSC) arms, all of which were initiated between 1982 and 2002. Although the number of randomized patients and the proportion of patients with metastatic disease had increased over the years, the number of patients with a poor performance status who were accrued into the trials had decreased. Cisplatin‐based chemotherapy was been investigated most frequently during the period. The multiple regression analysis revealed a significant improvement in median survival and in the median time to disease progression over the years, with annual prolongations of 0.1203 months (3.609 days) and 0.0617 months (1.851 days), respectively (P< .0001 and P < .0130, respectively). In addition, the use of cisplatin and carboplatin was associated significantly with survival prolongation. The median survival for patients who received BSC also increased progressively over the years (P = .0487).CONCLUSIONS.The survival of patients with NSCLC in Phase III trials improved slowly but steadily over time, although the main factors responsible for this improvement remain unknown. Nonetheless, the current results also suggested that novel targets and new agents will be required in the future fight against advanced NSCLC. Cancer 2007 © 2007 American Cancer Society.

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Meta-Analysis of Randomized Clinical Trials Comparing Cisplatin to Carboplatin in Patients With Advanced Non–Small-Cell Lung Cancer

Cited by 340 publications

References 23 publications

A phase 3 study of induction treatment with concurrent chemoradiotherapy versus chemotherapy before surgery in patients with pathologically confirmed N2 stage IIIA nonsmall cell lung cancer (WJTOG9903)

A phase 3 study of induction treatment with concurrent chemoradiotherapy versus chemotherapy before surgery in patients with pathologically confirmed N2 stage IIIA nonsmall cell lung cancer (WJTOG9903)

Phase II study of irinotecan combined with carboplatin in previously untreated small-cell lung cancer

Recent improvement in the survival of patients with advanced nonsmall cell lung cancer enrolled in phase III trials of first‐line, systemic chemotherapy

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