Maintenance or non-maintenance therapy in the treatment of advanced non-small cell lung cancer: that is the question.
ABSTRACT Lung cancer is the most common cancer worldwide with non-small cell lung cancer (NSCLC), including squamous carcinoma, adenocarcinoma and large cell carcinoma, accounting for about 85% of all lung cancer types with most of the patients presenting with advanced disease at the time of diagnosis. In this setting first-line platinum-based chemotherapy for no more than 4-6 cycles are recommended. After these cycles of treatment, non-progressing patients enter in the so called "watch and wait" period in which no further therapy is administered until there is disease progression. In order to improve the advanced NSCLC outcomes, the efficacy of further treatment in the "watch and wait" period was investigated. This is the "maintenance therapy". Recently, the results coming from randomized phase III trials investigating two new agents, pemetrexed and erlotinib, in this setting led to their registration for maintenance therapy. Here, we report and discuss these results.
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ABSTRACT: Maintenance therapy for advanced nonsmall cell lung cancer has shown some clinical benefit for patients by improving progression-free survival and, to a lesser extent, overall survival. Two main strategies exist for maintenance therapy, ie, continuation and switch maintenance. Continuation maintenance involves the continued use of one of the induction drugs beyond 4–6 cycles of initial treatment. Switch maintenance utilizes a third agent initiated after first-line chemotherapy. Both cytotoxic agents and targeted agents have been studied. Switch mainte-nance therapy with pemetrexed in nonsquamous tumors and erlotinib appear to show the most clear clinical benefit. Continuation maintenance with bevacizumab has shown improvement in progression-free survival. Data concerning the role of cetuximab for maintenance is conflicting. Toxicity, quality of life, and cost are important confounding issues that need to be considered. Several ongoing Phase III trials are investigating strategies to improve on the current agents as well as testing promising new therapies.Lung Cancer: Targets and Therapy 01/2011; 2:29-39.