Efficacy and safety of first-line carboplatin-versus cisplatin-based chemotherapy for non-small cell lung cancer: A meta-analysis.

OBJECTIVES: Platinum-based chemotherapy is the mainstay of first-line (1L) therapy for advanced non-small cell cancer (NSCLC). The objective of this study was to evaluate the relative efficacy, safety, and health-related quality of life (HRQoL) of carboplatin- versus cisplatin-based chemotherapy in 1L NSCLC. MATERIALS AND METHODS: A meta-analysis by the Cochrane group (2013) was updated. Systematic searches of CENTRAL, Medline, Embase, Latin American and Caribbean Health Sciences database, clinicaltrials.gov and conference proceedings were conducted to include randomized controlled trials (RCTs) published between 2013-January 2018 which compared carboplatin and cisplatin combined with: gemcitabine, vinorelbine, docetaxel, paclitaxel, irinotecan, or pemetrexed. Endpoints included overall survival (OS), one-year OS, objective response rate (ORR), grade 3/4 drug-related toxicities, and HRQoL. RESULTS: Twelve RCTs (2,048 patients) were identified from 4,139 records for inclusion in the meta-analysis. There were no significant differences in OS (hazards ratio [HR]: 1.08, 95% confidence interval [CI]: 0.96, 1.21) and one-year OS (relative risk [RR]: 0.97, CI: 0.89, 1.07) between carboplatin- and cisplatin-based chemotherapy. A small effect on ORR favouring cisplatin was detected (RR = 0.88; CI: 0.78, 0.99). Differences in drug-related toxicities were observed between carboplatin- and cisplatin-based chemotherapy for thrombocytopenia, anaemia, neurotoxicity, and the risk of nausea/vomiting. Three RCTs comparing HRQoL between carboplatin- and cisplatin-based chemotherapy found no significant differences. CONCLUSIONS: This updated evidence base corroborates findings of previous meta-analyses showing no difference in OS between carboplatin- and cisplatin-based chemotherapy, despite a slight benefit in ORR for cisplatin. Toxicity profiles should be considered alongside patients' comorbidities in the choice of therapy.

Gender and the diagnosis, management, and surveillance of chronic obstructive pulmonary disease.

Following in the footsteps of cardiovascular researchers and clinicians, the pulmonary scientific community is beginning to explore how gender may impact the diagnosis, treatment, and surveillance of chronic obstructive pulmonary disease (COPD). Investigators and clinicians in this field are tackling the complex questions surrounding how differences in male/female biology may interact with gender differences in environmental, societal, cultural, and behavioral determinants of health to influence outcomes in COPD. In this article, issues such as gender differences in symptoms, gender diagnostic bias, differential impact of therapies, including smoking cessation and pharmacologic management, as well as the impact of these issues on COPD surveillance, are discussed. Current knowledge from the literature coupled with discussions from a 1-day symposium on gender and COPD diagnosis, management, and surveillance are detailed, including recommendations on where future research endeavors may be targeted.