title: Comparative effectiveness of cisplatin-based and carboplatin-based chemotherapy for treatment of advanced urothelial carcinoma.
abstract: BACKGROUND
  Cisplatin-based chemotherapy is a standard treatment of metastatic urothelial carcinoma (UC), though carboplatin-based chemotherapy is frequently substituted due to improved tolerability. Because comparative effectiveness in clinical outcomes of cisplatin- versus carboplatin-based chemotherapy is lacking, a meta-analysis was carried out.
  
  
  METHODS
  PubMed was searched for articles published from 1966 to 2010. Eligible studies included prospective randomized trials evaluating cisplatin- versus carboplatin-based regimens in patients with metastatic UC. Individual patient data were not available and survival data were inconsistently reported. Therefore, the analysis focused on overall response (OR) and complete response (CR) rates. The Mantel-Haenszel method was used for combining trials and calculating pooled risk ratios (RRs).
  
  
  RESULTS
  A total of 286 patients with metastatic UC from four randomized trials were included. Cisplatin-based chemotherapy was associated with a significantly higher likelihood of achieving a CR [RR = 3.54; 95% confidence interval (CI) 1.48-8.49; P = 0.005] and OR (RR = 1.34; 95% CI 1.04-1.71; P = 0.02). Survival end points could not be adequately assessed due to inconsistent reporting among trials.
  
  
  CONCLUSIONS
  Cisplatin-based, as compared with carboplatin-based, chemotherapy significantly increases the likelihood of both OR and CR in patients with metastatic UC. The impact of improved response proportions on survival end points could not be assessed.
authors.affiliation: Division of Hematology/Oncology, The Tisch Cancer Institute, Mount Sinai School of Medicine, New York 10029, USA. matthew.galsky@mssm.edu
authors.forename: M D
authors.initials: MD
authors.lastname: Galsky
authors.forename: G J
authors.initials: GJ
authors.lastname: Chen
authors.forename: W K
authors.initials: WK
authors.lastname: Oh
authors.forename: J
authors.initials: J
authors.lastname: Bellmunt
authors.forename: B J
authors.initials: BJ
authors.lastname: Roth
authors.forename: R
authors.initials: R
authors.lastname: Petrioli
authors.forename: L
authors.initials: L
authors.lastname: Dogliotti
authors.forename: R
authors.initials: R
authors.lastname: Dreicer
authors.forename: G
authors.initials: G
authors.lastname: Sonpavde
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000556:secondary; D002945:Cisplatin / Q000627:therapeutic use*; D057186:Comparative Effectiveness Research; D005260:Female; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D014571:Urologic Neoplasms / Q000188:drug therapy* / Q000556:secondary
chemical_list: D016190:Carboplatin; D002945:Cisplatin