Comparative effectiveness of cisplatin-based and carboplatin-based chemotherapy for treatment of advanced urothelial carcinoma.

Abstract

e15027 Background: Cisplatin-based chemotherapy is the first-line treatment standard for metastatic urothelial carcinoma, though carboplatin-based chemotherapy is frequently substituted for reasons of improved tolerability and ease of administration. Because comparative effectiveness in clinical outcomes of cisplatin- versus carboplatin-based chemotherapy is lacking, a meta-analysis of published randomized trials was performed. Methods: PubMed was searched for articles published in the English language from 1966 until 2010. Eligible studies included prospective randomized trials evaluating cisplatin- versus carboplatin-based regimens in patients with metastatic urothelial carcinoma. Individual patient data were not available and progression and survival data were inconsistently reported. Therefore, the analysis focused on overall (OR) and complete response (CR). The Mantel-Haenszel method was used for combining trials and calculating pooled risk ratios (RR). Results: A total of 286 patients with metastatic urothelial carcinoma from 4 randomized trials (3 phase 2 and 1 phase 3 trial) were included. Cisplatin-based chemotherapy was associated with a significantly higher likelihood of achieving a CR (RR = 3.54; 95% CI: 1.48, 8.49; p = 0.005) and OR (RR = 1.34; 95% CI: 1.04, 1.71; p=0.02). Survival endpoints could not be adequately assessed due to inconsistent reporting among trials. Conclusions: Cisplatin-based, as compared with carboplatin-based, combination chemotherapy significantly increases the likelihoods of both OR and CR in patients with metastatic urothelial carcinoma. The impact of improved response proportions on survival endpoints could not be assessed. In the absence of definitive phase 3 trials, these results lend further support to the use of cisplatin-based combination chemotherapy as the preferred first-line treatment of metastatic urothelial carcinoma.