Review of the comparative pharmacology and clinical activity of cisplatin and carboplatin

Purpose: To review the pharmacodynamics, pharmacokinetics, toxicities, and relative clinical activities of cisplatin and carboplatin. Through a search of the MEDLINE database, we identified phase III clinical trials and pharm acologic studies comparing cisplatin and carboplatin published in the Engli sh language medical literature from January 1966 to December 1997. Results: Prospective randomized trials comparing cisplatin to carboplatin w ere identified for ovarian (n = 12), germ cell (n = 4), non-small-cell lung (n = I), small-cell lung (n = 3), and head and neck (n = 4) cancers. Carbo platin and cisplatin were equally effective in suboptimally debulked ovaria n cancer and extensive-stage small-cell lung cancer. One study each showed a trend toward better survival in favor of cisplatin for patients with opti mally debulked ovarian and limited-stage small-cell lung cancers. These res ults were, however, based on subset analyses. In germ cell tumors, carbopla tin was inferior because of lower relapse-free survival rates. Cisplatin pr oduced superior response rates and survival in head and neck cancers. There are no published randomized phase III studies of bladder, cervical, endome trial, and esophageal cancers. Conclusion: Carboplatin does not possess equivalent activity to cisplatin i n all platinum-sensitive tumors. Carboplatin can replace cisplatin in chemo therapy regimens for suboptimally debulked ovarian cancer. Two ongoing stud ies will address the same question in optimally debulked disease. Carboplat in can also be substituted for cisplatin in the treatment of non-small-cell and extensive stage small-cell lung cancers. Its role in limited-stage sma ll-cell lung cancer needs to be investigated further Carboplatin is inferio r to cisplatin in germ cell, head and neck, and esophageal cancers. Randomi zed studies are needed to determine whether carboplatin has equivalent effi cacy to cisplatin in bladder, cervical, and endometrial cancers. J Clin Oncol 17:409-422. (C) 1999 by American Society of Clinical Oncology.