Lung cancer is the leading cause of cancer-related mortality and the majority of patients (pts) are diagnosed with advanced or metastatic disease. Despite advances in targeted therapies for selected patient subgroups, the majority of pts (∼80%) are treated with platinum-based doublet chemotherapies (CT). The choice between the platinum agents cisplatin (CIS) or carboplatin (CAR) has been subject of a long debate. Here we present data on the treatment of advanced non-small cell lung cancer (aNSCLC) in routine practice. Such real-world data are of central importance to improve the standard of care.
107 sites in Germany recruited 1,239 pts with aNSCLC at start of 1st-line therapy into the prospective clinical cohort study TLK (Tumour Registry Lung Cancer) between Feb 2010 and Dec 2013. Details on systemic treatment and outcome were collected until Jan 2016. A longitudinal health-related quality of life (HRQOL) analysis using the questionnaires EORTC QLQ-C30 and –LC13 was conducted every 2 months (mts) for a period of up to 10 months.
46% of the pts received CAR- and 35% CIS-based doublet CT in 1st-line treatment. Pts receiving CIS- were younger than pts receiving CAR-combinations (median age at start of treatment 62 vs. 69 years), more often had a good performance status (33% vs. 17% ECOG =0) and less comorbidities (34% vs. 56% Charlson Comorbidity Index ≥1). The main combination partner was pemetrexed for CIS (33%) and paclitaxel for CAR (24%). Median overall survival was 11.9 mts (95% CI 10.2-13.8) for CIS- and 12.2 mts (95% CI 10.0-13.3) for CAR-combinations. The median time to deterioration of the global health status was 6.8 mts for CIS- and 6.4 mts for CAR-combinations. Considerable deteriorations in the symptoms nausea, fatigue, dyspnoea and pain were reported after 4-6 mts, with no difference between CIS and CAR.
Numerous meta analyses have been dedicated to finding the optimal platinum agent for the 1st-line treatment of aNSCLC. With our data from the prospective, population-based cohort study TLK, we complement the results from clinical trials. We show that there is no considerable difference in outcome or HRQOL between CIS- and CAR-combinations in the treatment of aNSCLC.
Clinical trial identification
Legal entity responsible for the study
Roche Pharma AG, Boehringer Ingelheim Pharma GmbH & Co. KG, Onkovis GmbH, TEVA Deutschland GmbH
N. Marschner: Roche Pharma AG: Travel Grant + Advisory Board Fee. All other authors have declared no conflicts of interest.