cysplatin vs carboplatin - 1267157

Hi cleut,

Welcome to GRACE. There is some evidence that cisplatin may be a bit more effective than carboplatin, but that remains a matter of controversy among oncologists, and many use carboplatin especially with patients for whom the side effects of cisplatin may be very difficult to tolerate. A slightly more effective regimen isn't better if the course of treatment can't be completed because of its side effects.

You may find it helpful to read this thread. In that discussion, Dr. Weiss sums up his thinking as follows:

"It's worth clarifying that while carbo has less side effects than cis for just about everything else, it does suppress blood counts more than carbo.

As for efficacy, cisplatin has been much better studied than carboplatin in the adjuvant setting, and most of us prefer it in the adjuvant setting for patients sufficiently fit to tolerate it. In my opinion, the limited data that we have comparing cisplatin and carboplatin in the incurable/stage IV/metastatic setting do not support any significant advantage in terms of survival for cisplatin, especially when carboplatin is dosed sufficiently aggressively.

This is a controversial and confusing topic, I realize. To summarize my take: In the adjuvant setting, I favor cis, but will accept carbo in a patient would is a poor candidate for cis. In the metastatic setting I almost always favor carbo over cis, although I don't think that those docs who favor cis are entirely crazy."

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"I should add a detail to that final point. While cis is a tough drug to handle, it has gotten more tolerable over the years thanks to better supportive care. Nausea has been dramatically improved with the use of 5-ht3 antagonists (aloxi, zofran and the like) as well as aprepitant (emend) and steroids. The risk of kidney damage is reduced with the use of IV fluid and mannitol (a diuretic that flushes the kidneys). However, I still think that from a quality of life standpoint, carbo is the superior drug for most patients. To me and to most of my patients, quality of life matters at least (if not more) than duration of life."

I would also add that it is not the age of the patient, but the overall health of that patient which matters. There are very fit 79-year olds and very frail patients that same age, just as the health of a 60-year old patient can vary greatly.

JimC
Forum moderator

Jim has summarized the subject well. We typically favor cisplatin over carbo as a post-operative, adjuvant therapy in patients fit enough to tolerate it, but most US oncologists favor carboplatin over cisplatin for advanced disease based on the more favorable side effect profile and comparable activity. It's very reasonable to be more inclined toward carboplatin than cisplatin in a 79 year old, including as adjuvant therapy.

-Dr. West

cleut,

I share your hope that your mom will tolerate cisplatin well. It really varies from patient to patient; some patients have difficulty with regimens that others find relatively easy, and vice versa.

And there's no other way to look at the situation other than with hope. Keeping in mind that the cure rate for limited stage SCLC is more like 25%, perhaps this post from Neil, one of GRACE's first two moderators, will help put this in perspective in a positive way: http://cancergrace.org/forums/index.php?topic=826.msg4326#msg4326

JimC
Forum moderator

The rationale for cisplatin is understandable in a curative setting -- it's really a very debatable case with no clear answer, especially in a 79 year old. You might get a 50/50 split on the recommendation for cisplatin vs. carboplatin among a panel of multiple experts. We don't want to discriminate by age, but sometimes you turn a very fit 79 year old into a much less fit 79 year old with chemotherapy. That vitality may be a thin veneer, and even a fit 79 year old has 79 year old kidneys, liver, etc. So it remains a judgment call.

One other point I'd make is that the stats for SCLC don't apply that much to an incidentally discovered very early SCLC that is treated with surgery. Whether that's because of the surgery followed by later treatments or because any SCLC that is detectable as an incidental early finding is not a typically aggressive SCLC isn't clear. Regardless, outcomes in "very limited stage" SCLC are quite a bit better than those that we see in the other 95% of patients with regionally involved limited SCLC or extensive SCLC.

You can read more here:

http://cancergrace.org/lung/2008/06/29/surgery-for-sclc-2/

Good luck.

-Dr. West