Comparative Efficacy and Cycle-Wise Toxicity of Paclitaxel-Carboplatin Versus Gemcitabine-Cisplatin in Stage IV Non-small Cell Lung Cancer (NSCLC): A Quasi-experimental Study in Bangladesh

Background Non-small cell lung cancer (NSCLC) remains a leading cause of cancer mortality worldwide. In Bangladesh, limited access to novel therapeutics makes platinum-based chemotherapy the mainstay of treatment. This study compares the efficacy and cycle-wise toxicity profiles of paclitaxel-carboplatin versus gemcitabine-cisplatin in Stage IV NSCLC patients. Methods In this quasi-experimental study, 66 Stage IV NSCLC patients at Ahsania Mission Cancer & General Hospital, Dhaka, received paclitaxel-carboplatin (Group A) or gemcitabine-cisplatin (Group B). Tumor response, six- and nine-month survival, and hematologic (e.g., neutropenia, thrombocytopenia) and non-hematologic (e.g., nausea, vomiting) toxicities were assessed over three chemotherapy cycles. Statistical analysis included Chi-square, Mann-Whitney, or t-tests; p < 0.05 was considered significant. Results A partial response was observed in 18 (54.6%) of patients in both groups, with no complete responses recorded. Disease control rates were 26 (78.8%) in Group A and 25 (75.8%) in Group B (p = 0.716). Six-month survival rates were 18 (54.5%) and 20 (60.9%). Nine-month survival rates decreased to 10 (30.3%) and 12 (36.4%), respectively. Group A experienced significantly higher rates of leukopenia and neutropenia across all cycles, with six-cycle incidences of 25 (75.8%) and 26 (78.8%), respectively (p < 0.05). At the same time, thrombocytopenia was notably more common in Group B, with 21 (63.6%) over six cycles (p < 0.05). Non-hematologic toxicities were mild and statistically similar between groups. Conclusions Paclitaxel-carboplatin and gemcitabine-cisplatin demonstrated comparable efficacy and short-term survival. However, their distinct hematologic toxicity profiles highlight the need for individualized regimen selection based on patient tolerance and supportive capacity in resource-limited settings.