Maintenance therapy in non-small cell lung cancer

Abstract

Several randomized trials have investigated the role of maintenance treatment for patients with advanced non-small cell lung cancer (NSCLC) not progressed after completion of first-line chemotherapy, with good performance score (PS) and no persistent chemotherapy-induced toxicity. Two separate strategies have been developed: the immediate use of non-cross-resistant drug (switch maintenance or early second-line therapy) or the continuation of platinum partner alone (continuation maintenance) or in combination with other drug (combination maintenance). Here we discuss how the benefits demonstrated in these studies may change clinical practice (in terms of potential toxicity and costs) and reflect on factors that may identify subgroups of patients who might benefit from maintenance therapy in general, and which maintenance therapy specifically.

Keywords:

• advanced non-small cell lung cancer
• lung cancer
• maintenance therapy
• Phase III randomized trial
• review

Financial and competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties

Key issues

• Systemic therapies have improved survival in NSCLC but overall outcome results remain disappointing.

• Continuation maintenance therapy with the same agents given as first-line therapy may prolong the disease control rate.

• Switch maintenance or early second-line therapy might overcome tumor resistance and prolong the disease control interval.

• Combination maintenance therapy did not show a clear benefit in survival.

• Maintenance therapy imposes a reflection on economic issues.