Carboplatin could replace cisplatin in treatment of gastro-oesophageal cancer
There is no significant difference in progression-free survival (PFS) or endoscopic biopsy complete response (CR) rate between patients with localized gastro-oesophageal carcinoma (GOC) undergoing radical chemoradiation therapy (CRT) with carboplatin and those with cisplatin, according to a study presented at the European Society for Medical Oncology (ESMO) Asia 2017 Congress.
“The combination of cisplatin and fluoropyrimidine is a standard option in the treatment of GOC. However, cisplatin is not suitable for patients with renal impairment, hearing impairment, neuropathy or significant cardiac dysfunction,” researchers said. In these situations, there is a lack of prospective comparative data for platinum substitution with carboplatin.
To assess the use and outcomes of cisplatin vs carboplatin, a retrospective analysis was conducted on patients with localized GOC who had undergone radical CRT utilizing cisplatin or carboplatin at The Royal Marsden Hospital in UK between 2001 and 2014. Those administered neoadjuvant chemotherapy containing epirubicin were excluded from the analysis in order to attain two comparable groups.
Descriptive statistics was used to analyse participant and disease characteristics. PFS and overall survival (OS) were estimated using the Kaplan-Meier method. Researchers used Cox regression method to compare survival rates between the two groups and to adjust for effect of covariates.
A total of 91 patients were included in the analysis (cisplatin, n=42; carboplatin, n=49). Patients in the carboplatin vs cisplatin group tended to be older (median 77 vs 65 years) with greater comorbidity and higher proportion of adenocarcinoma histology (median PFS, 31.0; 95 percent CI, 18.2 to NE vs 18.7; 13.5 to 30.4; hazard ratio, 1.54; 0.89 to 2.67; p=0.12). [ESMO Asia 2107, abstract 199P]
“These differences in baseline characteristics remained when the analysis was restricted to those who received carboplatin substitution for renal or hearing impairment as the primary reason,” researchers said. “Differences in baseline characteristics limit any comparative assessment of outcome.”
After adjusting for the said factors, no significant difference was observed in PFS or OS between the carboplatin and cisplatin group. It appeared that OS was longer in the cisplatin group, but this must be interpreted with caution due to the differing characteristics of patients within the two groups.
“These findings support the utilization of carboplatin substitution in this patient population, where the use of cisplatin is often contraindicated [or potentially dangerous],” researchers said.
In another retrospective analysis of patients undergoing CRT with carboplatin and paclitaxel and CRT with cisplatin and 5-fluorouracil, the investigators found no significant difference for OS and freedom from relapse between the two treatment options. However, use of cisplatin and 5-fluorouracil correlated with significantly more haematologic III°- toxicities compared to carboplatin and paclitaxel. [Radiat Oncol 2017 21;12:182]
On the other hand, another study found that in a definitive CRT, a better OS was reported in patients receiving cisplatin and 5-fluorouracil (median OS, 28 months; 19 to 41 months) than in those receiving carboplatin and paclitaxel (median OS, 15 months; 11 to 17 months). [Curr Oncol 2017;24:e379–e387]