Meta-analysis comparing carboplatin and cisplatin-based chemotherapy in advanced non-small cell lung cancer

7218 Background: It is recommended that first-line chemotherapy given to patients with metastatic non-small cell lung cancer (NSCLC) consist of a 2 drug platinum-based combination. The primary objective of this meta-analysis is to compare the efficacy of carboplatin-based and cisplatin-based chemotherapy in terms of median survival in patients with advanced NSCLC. Methods: A literature search was performed using MEDLINE. We selected phase III trials which compared carboplatin-containing and cisplatin-containing regimens in advanced NSCLC. Outcomes recorded were: median survival, 1-year survival rate, and overall response rate. The primary effect measure was difference in median survival between the carboplatin and cisplatin regimens in months. Statistical analysis was performed using Stata version 7.0. Fixed-effects and random-effects models were used to calculate the pooled estimates of difference in median survival, relative risk (RR) of 1-year survival, and RR of overall response. Results were summarised on forest plots. Heterogeneity was assessed using the Q-test and Gallbraith plots. Results: 10 studies were selected for primary analysis, providing 14 carboplatin vs. cisplatin comparisons from 1990 to 2003. There were 3171 patients in carboplatin regimens and 3168 patients in cisplatin regimens. The pooled estimate for difference in median survival is -0.36 months with 95% confidence intervals (CI) of -0.91 to 0.19. The pooled estimate for 1-year survival RR is 0.99, 95% CI 0.94 to 1.05. The pooled estimate for overall response RR is 0.91, 95% CI 0.86 to 0.97. In the subgroup analysis of carboplatin vs. cisplatin comparisons in which the non-platinum drug is the same, the pooled estimate for difference in median survival is -1.03 months with 95% CI -2.13 to 0.09. Conclusions: Carboplatin-based and cisplatin-based chemotherapy are equivalent in advanced NSCLC as assessed by median survival and 1-year survival. There is a slight statistical superiority for cisplatin in terms of overall response rate, but this difference may not be clinically significant. There is a statistical trend towards a benefit in median survival in favour of cisplatin when the non-platinum drug is the same. No significant financial relationships to disclose.