Lokich J, Anderson N
Cancer Center of Boston, MA, USA.
Ann Oncol. 1998 Jan;9(1):13-21. doi: 10.1023/a:1008215213739.
Introduced into clinical usage in 1992 as a platinum analogue with a distinctively different toxicity profile from cisplatin, carboplatin has become a commonly preferred agent over cisplatin. The comparative therapeutic efficacy of the two agents remains controversial however, prompting an analysis of the phase III trials in ovarian cancer and other tumors in which the two were compared.
Clinical trials comparing carboplatin with cisplatin, both as single agents and in combination with other agents, were analyzed within the tumors for which platinum has become a standard or commonly employed agent. A Medline search identifying the randomized trials and references from these reports were collated for analysis.
The original clinical comparative trials as well as literature reviews and commentaries were reviewed. Five solid tumors were identified within which comparative trials had been conducted: ovary, 10 trials; lung, 2 trials; head and neck, 2 trials; germ cell tumors, 3 trials and 1 trial in bladder cancer. Depending upon the end point selected, cisplatin was superior or equivalent to carboplatin in therapeutic efficacy in all five tumors but was associated with an increased toxicity profile for gastrointestinal, renal and neurologic effects.
For some tumors, cisplatin appears to be superior to carboplatin in terms of therapeutic effectiveness (germ cell tumors, bladder cancer, head and neck cancer), while for others, effectiveness is comparable (lung cancer, ovarian cancer). Toxicity profiles are distinctly different for the two analogues however, generally favoring carboplatin. The issue of potential carboplatin underdosing related to the lack of physiologic dose calculations (utilizing the AUC [area under the curve] method) in the comparative trials of cis- versus carboplatin is probably not clinically important since a dose response effect has not been established for carboplatin or for cisplatin. The selection of the optimal platinum analogue to be employed is dependent on the type of tumor, the treatment intention (palliative vs. curative) and the other component drugs being used in combination.
卡铂于1992年作为一种铂类类似物引入临床应用，其毒性特征与顺铂明显不同，已成为比顺铂更常用的首选药物。然而，这两种药物的相对治疗效果仍存在争议，促使人们对卵巢癌和其他肿瘤的III期试验进行分析，在这些试验中对两者进行了比较。
在铂已成为标准或常用药物的肿瘤中，分析了比较卡铂与顺铂作为单一药物以及与其他药物联合使用的临床试验。通过医学文献数据库检索识别随机试验，并整理这些报告中的参考文献进行分析。
回顾了最初的临床比较试验以及文献综述和评论。确定了五个进行过比较试验的实体瘤：卵巢癌，10项试验；肺癌，2项试验；头颈部癌，2项试验；生殖细胞肿瘤，3项试验；膀胱癌，1项试验。根据所选终点，在所有五种肿瘤中，顺铂在治疗效果上优于或等同于卡铂，但胃肠道、肾脏和神经方面的毒性增加。
对于某些肿瘤，顺铂在治疗效果方面似乎优于卡铂（生殖细胞肿瘤、膀胱癌、头颈部癌），而对于其他肿瘤，效果相当（肺癌、卵巢癌）。然而，这两种类似物的毒性特征明显不同，一般更倾向于卡铂。在顺铂与卡铂的比较试验中，由于缺乏生理剂量计算（采用曲线下面积[AUC]法）导致卡铂潜在剂量不足的问题可能在临床上并不重要，因为尚未确定卡铂或顺铂的剂量反应效应。选择使用的最佳铂类类似物取决于肿瘤类型、治疗意图（姑息性与根治性）以及联合使用的其他成分药物。
