title: Carboplatin- or cisplatin-based chemotherapy in first-line treatment of small-cell lung cancer: the COCIS meta-analysis of individual patient data.
abstract: OBJECTIVE
  Since treatment efficacy of cisplatin- or carboplatin-based chemotherapy in the first-line treatment of small-cell lung cancer (SCLC) remains contentious, a meta-analysis of individual patient data was performed to compare the two treatments.
  
  
  METHODS
  A systematic review identified randomized trials comparing cisplatin with carboplatin in the first-line treatment of SCLC. Individual patient data were obtained from coordinating centers of all eligible trials. The primary end point was overall survival (OS). All statistical analyses were stratified by trial. Secondary end points were progression-free survival (PFS), objective response rate (ORR), and treatment toxicity. OS and PFS curves were compared by using the log-rank test. ORR was compared by using the Mantel-Haenszel test.
  
  
  RESULTS
  Four eligible trials with 663 patients (328 assigned to cisplatin and 335 to carboplatin) were included in the analysis. Median OS was 9.6 months for cisplatin and 9.4 months for carboplatin (hazard ratio [HR], 1.08; 95% CI, 0.92 to 1.27; P = .37). There was no evidence of treatment difference between the cisplatin and carboplatin arms according to sex, stage, performance status, or age. Median PFS was 5.5 and 5.3 months for cisplatin and carboplatin, respectively (HR, 1.10; 95% CI, 0.94 to 1.29; P = .25). ORR was 67.1% and 66.0%, respectively (relative risk, 0.98; 95% CI, 0.84 to 1.16; P = .83). Toxicity profile was significantly different for each of the arms: hematologic toxicity was higher with carboplatin, and nonhematologic toxicity was higher with cisplatin.
  
  
  CONCLUSIONS
  Our meta-analysis of individual patient data suggests no differences in efficacy between cisplatin and carboplatin in the first-line treatment of SCLC, but there are differences in the toxicity profile.
authors.affiliation: S.G. Moscati Hospital, Avellino, Città Ospedaliera, Contrada Amoretta, Avellino, Italy. arossi_it@yahoo.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Rossi
authors.forename: Massimo
authors.initials: M
authors.lastname: Di Maio
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
authors.forename: Robin Michael
authors.initials: RM
authors.lastname: Rudd
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Okamoto
authors.forename: Dimosthenis Vasilios
authors.initials: DV
authors.lastname: Skarlos
authors.forename: Martin
authors.initials: M
authors.lastname: Früh
authors.forename: Wendi
authors.initials: W
authors.lastname: Qian
authors.forename: Tomohide
authors.initials: T
authors.lastname: Tamura
authors.forename: Epaminondas
authors.initials: E
authors.lastname: Samantas
authors.forename: Taro
authors.initials: T
authors.lastname: Shibata
authors.forename: Francesco
authors.initials: F
authors.lastname: Perrone
authors.forename: Ciro
authors.initials: C
authors.lastname: Gallo
authors.forename: Cesare
authors.initials: C
authors.lastname: Gridelli
authors.forename: Olga
authors.initials: O
authors.lastname: Martelli
authors.forename: Siow-Ming
authors.initials: SM
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D016190:Carboplatin; D002945:Cisplatin