CISCA (cisplatin vs. carboplatin) meta-analysis: An individual patient data meta-analysis comparing cisplatin versus carboplatin-based chemotherapy in first-line treatment of advanced non-small cell lung cancer (NSCLC).
CISCA (cisplatin vs. carboplatin) meta-analysis: An individual patient data meta-analysis comparing cisplatin versus carboplatin-based chemotherapy in first-line treatment of advanced non-small cell lung cancer (NSCLC).
复制标题
CISCA（顺铂与卡铂）荟萃分析：对晚期非小细胞肺癌 (NSCLC) 一线治疗中顺铂与卡铂化疗进行比较的个体患者数据荟萃分析。
DOI：
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发表时间：
2006
影响因子：
45.3
通讯作者：
D. Bisset
中科院分区：
文献类型：
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作者：
A. Ardizzoni;M. Tiseo;L. Boni;R. Rosell;F. Fossella;J. Schiller;M. Paesmans;D. Radosavljević;A. Paccagnella;P. Mazzanti;D. Bisset
7011背景：卡铂和顺铂治疗晚期非小细胞肺癌的等效性问题仍有争议。为了回答这个问题，我们对比较顺铂和卡铂为基础的化疗（CT）一线治疗晚期NSCLC的随机试验进行了个体患者（PT）数据荟萃分析。
方法
进行了文献检索，以识别研究在晚期NSCLC的一线CT中卡铂替代顺铂联合相同药物的随机试验。主要终点为总生存期（OS），次要终点为缓解率（RR）和毒性。对于每个终点，分析基于固定效应模型。对于对OS的影响的研究，使用考克斯比例风险模型。使用逻辑回归模型研究客观缓解或不良事件的概率。
结果
确定了9项试验，并获得了相关数据库。总共有2，968例患者被随机分配分别接受顺铂（1，489例）或卡铂（1，479例）CT。顺铂和卡铂为基础的CT的RR分别为30%和24%，OR为1.37（95% CI：1.16-1.62; p < 0.001）。关于OS，卡铂与死亡的相对风险比顺铂高7%相关，即使该差异无统计学显著性（HR = 1.07; 95% C.I.：0.99-1.15; p = 0.101）。顺铂为基础的CT患者有更多的恶心呕吐和肾毒性，而血小板减少症更常见于卡铂为基础的CT。亚组分析显示，在非鳞状肿瘤患者亚组和接受第三代CT治疗的患者中，基于顺铂的CT在生存率方面具有统计学显著优势。
结论
CISCA是关于该受试者的首个个体患者数据荟萃分析。我们发现，在RR方面，顺铂为基础的CT上级优于卡铂为基础的CT;然而，RR增加并不能转化为OS获益。然而，选定的晚期NSCLC患者可能从含顺铂的第三代CT中获得略多的获益。无重大财务关系需要披露。
7011 Background: The issue of the equivalence between carboplatin and cisplatin in the treatment of advanced NSCLC is still controversial. To answer this question, we conducted an individual patient (pt) data meta-analysis of randomized trials comparing cisplatin- and carboplatin-based chemotherapy (CT) in first-line treatment of advanced NSCLC.
METHODS
A literature search was performed to identify randomized trials investigating the substitution of carboplatin for cisplatin, combined with the same agent/s, in the first-line CT of advanced NSCLC. The primary end-point was overall survival (OS) and the secondary end-points were response rate (RR) and toxicity. For each end-point the analysis was based on a fixed-effects model. For the study of the effect on OS, Cox proportional hazards model was used. The probability to have an objective response or an adverse event was studied using a logistic regression model.
RESULTS
Nine trials were identified and the relative databases obtained. In total, 2,968 pts were randomized to receive CT with cisplatin (1,489) or with carboplatin (1,479), respectively. The RR was 30% and 24% for cisplatin- and carboplatin-based CT, respectively, with an OR of 1.37 (95% C.I.: 1.16-1.62; p < 0.001). Concerning the OS, carboplatin was associated with a relative risk of death 7% higher compared with cisplatin, even if this difference was not statistically significant (HR = 1.07; 95% C.I.: 0.99-1.15; p = 0.101). Patients on cisplatin-based CT had more nausea-vomiting and nephro-toxicity while thrombocytopenia was more frequent during carboplatin-based CT. Subgroup analyses revealed that cisplatin-based CT led to statistically significant advantage in survival in the subgroups of pts with non-squamous tumours and in those treated with third generation CT.
CONCLUSIONS
CISCA is the first individual pt data meta-analysis on this subject. We found that cisplatin-based is superior to carboplatin-based CT in terms of RR; however, the increased RR does not translate into an OS benefit. Nevertheless, selected pts with advanced NSCLC may obtain slightly more benefit from cisplatin-based third generation CT. No significant financial relationships to disclose.