Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :1106
Small font sizeDefault font sizeIncrease font size
Navigate here
Resource links
   Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
   Article in PDF (266 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

  In this article

 Article Access Statistics
    PDF Downloaded234    
    Comments [Add]    
    Cited by others 1    

Recommend this journal


  Table of Contents  
Year : 2011  |  Volume : 48  |  Issue : 4  |  Page : 452-453

Can Carboplatin replace Cisplatin in small cell lung cancer?

Consultant Surgical Oncologist, Tata Memorial Hospital, Parel, Mumbai, India

Date of Web Publication25-Jan-2012

Correspondence Address:
V Noronha
Consultant Surgical Oncologist, Tata Memorial Hospital, Parel, Mumbai
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-509X.92278

Rights and Permissions

How to cite this article:
Noronha V. Can Carboplatin replace Cisplatin in small cell lung cancer?. Indian J Cancer 2011;48:452-3

How to cite this URL:
Noronha V. Can Carboplatin replace Cisplatin in small cell lung cancer?. Indian J Cancer [serial online] 2011 [cited 2022 May 29];48:452-3. Available from:

In the recent past, our understanding of non-small cell lung cancer (NSCLC) has significantly expanded in terms of molecular pathogenesis, new targets and improved therapies. Small cell lung cancer unfortunately remains as much a mystery as it was about 30 years ago, without significant advances in our understanding of the disease biology. However, we have learned better ways of administering old chemotherapy, to enhance acceptability and decrease toxicity. We welcome the article from Turkey in this issue of the IJC which highlights current epidemiological data on NSCLC from India and an article from Turkey describing a non-Cisplatin regimen for the first-line therapy of extensive stage small cell lung cancer.

In 1979, Sierocki first reported on the remarkable activity of a combination of Cisplatin and Etoposide in patients with small cell lung cancer. [1] In 1985, Evans et al. confirmed that this is an active regimen with a complete remission rate of 43% and an additional 43% of the patients had a partial remission. The median survival of patients with extensive disease who demonstrated a response to Cisplatin/Etoposide was 9.5 months. [2] This regimen has gone on to become the standard first-line therapy in patients with small cell lung cancer, both for extensive stage disease and for limited stage. However, Cisplatin is problematic in terms of emetogenicity, nephrotoxocity, ototoxicity, dyselectrolytemia and the need for significant amount of accompanying hydration. Several studies have examined if Carboplatin may be substituted for Cisplatin, without significantly compromising the efficacy. In 1987, Smith et al. from the Royal Marsden reported that the combination of Carboplatin and Etoposide is effective with a response rate of 88% (13% complete remission rate) in extensive disease. [3] Okamoto et al. reported that Carboplatin AUC 5 with Etoposide 80 mg/m 2 daily for 3 days was equivalent to split doses of Cisplatin 25 mg/m 2 and Etoposide 80 mg/m 2 , both given daily for 3 days. There was no difference in the response rate, median survival or toxicity, except for thrombocytopenia which was higher in the Carboplatin-based regimen. [4]

In this issue of the IJC, Yilmaz et al. add another study to the body of evidence supporting the use of Carboplatin in this patient population. The group from Turkey treated 88 patients having extensive stage small cell lung cancer with six cycles of Carboplatin AUC 6 on day 1 and Etoposide 100 mg/m 2 for 3 days. Little over half of the patients completed six courses of chemotherapy. The objective response rate was 70% with 24% complete response (CR), 46% partial response (PR) and 8% stable disease. The median progression-free survival (PFS) was 7.2 months and the overall median survival was 9 months. Hematological toxicity was substantial, with almost 60% of patients experiencing grade 3 or 4 neutropenia and 14% of patients developing febrile neutropenia. 16% of the patients developed grade 3 or 4 thrombocytopenia. Non-hematologic toxicity was insignificant. There were no toxic deaths. Although this was not a randomized trial, results appear to be comparable to the earlier studies in the literature, both for Carboplatin-based regimens as well as Cisplatin-based regimens.

Should we therefore routinely use the combination of Carboplatin with Etoposide as first-line therapy in extensive stage small cell carcinoma? The answer is a guarded yes. One must be watchful for hematologic toxicity and manage it appropriately, with a low threshold for the use of growth factors. The bottom line is that a Carboplatin-based regimen may be administered more easily, with equivalent survival results and palliation.

  References Top

1.Sierocki JS, Hilaris BS, Hopfan S, Martini N, Barton D, Golbey RB, et al. cis-Dichlorodiammineplatinum(II) and VP-16-213: An active induction regimen for small cell carcinoma of the lung. Cancer Treat Rep 1979;63:1593-7.  Back to cited text no. 1
2.Evans WK, Shepherd FA, Feld R, Osoba D, Dang P, et al. VP-16 and cisplatin as first-line therapy for small-cell lung cancer. J Clin Oncol 1985;3:1471-7.  Back to cited text no. 2
3.Smith IE, Evans BD, Gore ME, Vincent MD, Repetto L, et al. Carboplatin (Paraplatin; JM8) and etoposide (VP-16) as first-line combination therapy for small-cell lung cancer. J Clin Oncol 1987;5:185-9.  Back to cited text no. 3
4.Okamoto H, Watanabe K, Kunikane H, Yokoyama A, Kudoh S, et al. Randomised phase III trial of carboplatin plus etoposide vs split doses of cisplatin plus etoposide in elderly or poor-risk patients with extensive diseasesmall-cell lung cancer: JCOG 9702. Br J Cancer 2007;97:162-9.  Back to cited text no. 4

This article has been cited by
Sourav Chakraborty, Saugata Ghosh
Journal of Evidence Based Medicine and Healthcare. 2018; 5(15): 1301
[Pubmed] | [DOI]


Print this article  Email this article


  Site Map | What's new | Copyright and Disclaimer | Privacy Notice
  Online since 1st April '07
  2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow