Rethinking the Platinum Standard in SCLC: A Meta-Analysis of Limited- and Extensive-Stage Disease in the Immunotherapy Era
In brief
In limited-stage SCLC, immunotherapy improved survival in carboplatin trials, not cisplatin trials
A meta-analysis of seven trials found immunotherapy reduced the risk of death by about 29% in limited-stage patients receiving carboplatin, while cisplatin trials showed no statistically clear survival benefit. In extensive-stage disease, both platinum regimens improved survival with immunotherapy. Because these are comparisons across trials, not a direct carboplatin-versus-cisplatin test, which backbone is best remains uncertain.
- Journal
- JTO clinical and research reports (Q1)
- Published
- 24 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Tomer Meirson, Hadas Ditzian Kugler, Ekaterina Hanovich, Ofer Rotem, Mor Moskovitz, Ari Raphael
- PMID
- 42893056
- DOI
- 10.1016/j.jtocrr.2026.101055
Why clinicians should know about it
- Picked for Pulmonary and Respiratory Medicine (paper of the day, 19 October 2026): Meta‑analysis of platinum agents in limited/extensive SCLC
- Picked for Oncology and Radiation Oncology (paper of the day, 19 October 2026): Meta-analysis of platinum backbone in SCLC with immunotherapy
Abstract
INTRODUCTION: SCLC is an aggressive malignancy for which platinum-based chemotherapy is the cornerstone of treatment. Although immunotherapy has redefined the standard of care, the optimal choice between cisplatin and carboplatin remains debated. This study evaluated the impact of platinum backbone selection on survival outcomes across the SCLC spectrum in the immunotherapy era. METHODS: A systematic review and meta-analysis were performed on randomized controlled trials evaluating first-line chemoimmunotherapy with platinum-based regimens in SCLC. Outcomes were stratified by disease stage and platinum backbone (carboplatin versus cisplatin). Survival end points included progression-free survival (PFS) and overall survival (OS). RESULTS: Seven trials (3059 patients) were analyzed. In extensive-stage SCLC (n = 1843), both backbones provided comparable benefits when combined with immunotherapy; the pooled OS hazard ratio (HR) for cisplatin was 0.71 (95% confidence interval [CI]: 0.57-0.89; p = 0.003) and 0.76 for carboplatin (95% CI: 0.68-0.85; p < 0.001). In limited-stage SCLC (n = 1216), the addition of immunotherapy improved OS (HR: 0.71; 95% CI: 0.54-0.92; p = 0.01) and PFS (HR: 0.70; 95% CI: 0.56-0.87; p = 0.002) in carboplatin-treated patients, whereas, in cisplatin-treated patients the benefit did not reach statistical significance for OS (HR: 1.15; 95% CI: 0.77-1.72; p = 0.49) or PFS (HR: 1.02; 95% CI: 0.81-1.28; p = 0.87). CONCLUSION: These findings invite a reconsideration of the platinum hierarchy in SCLC management. By demonstrating that carboplatin provides a more effective backbone in the limited-stage setting and comparable efficacy in the extensive-stage setting, this analysis suggests that the historical prioritization of cisplatin may no longer be justified in the era of immunotherapy. Prioritizing carboplatin as a preferred agent may optimize tolerability while preserving or improving survival outcomes across the SCLC spectrum.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.