Cisplatin versus carboplatin: comparative review of therapeutic management in solid malignancies

• Cisplatin and carboplatin, represent some of the most active cytotoxic agents and are the backbone of most chemotherapeutic regimens.
• Despite their relative similarities in mechanisms of action, there are significant differences in efficacy and toxicity in various malignancies.
• Carboplatin is a useful alternative in situations where cisplatin is contraindicated and this is not universally at the expense of efficacy.
• De novo and acquired platinum resistance is inevitable and understanding the mechanisms of resistance is essential in improving outcomes.

The platinum analogues, cisplatin and carboplatin, are among the most widely used chemotherapeutic agents in oncology. Both agents have a broad spectrum of clinical activity in numerous malignancies including gynaecological cancers, germ cell tumours, head and neck cancer, thoracic cancers and bladder cancer. Although the final mechanism of inducing tumour cell apoptosis is similar for both compounds, cisplatin has been shown to be more effective in treating specific tumour types. Whilst more favourable toxicity profiles are often associated with carboplatin, this can frequently translate to inferior response in certain malignancies. This review succinctly collates the evidence for the preferential use of these platinum analogues in particular settings in addition to the long-standing dilemma surrounding the paucity of biomarkers predicting response to these agents.