Maintenance treatment after induction therapy in non-small cell lung cancer: latest evidence and clinical implications

Abstract

Non-small cell lung cancer (NSCLC) is the leading cause of cancer death in the industrialized world. Despite significant progress in early stage disease, survival rates for advanced disease remain low. Maintenance therapy is a treatment strategy that has been investigated extensively in NSCLC. Therapies that have been studied in this setting in randomized trials to date include chemotherapy and molecularly targeted agents. Following the development of multiple new agents that show activity in NSCLC and have a tolerable side-effect profile, there has been increasing interest in utilizing them to maintain response to initial therapy after treatment with platinum-based doublets. Two effective strategies have evolved: continuation and switch maintenance. Despite improvements in progression-free survival and often overall survival on multiple clinical trials, there remains considerable controversy around this treatment paradigm. Here, we briefly outline the evolution of this treatment strategy and examine the available data, including recently updated data from the PARAMOUNT, AVAPERL, and PointBreak maintenance trials. Ultimately, the decision to use maintenance chemotherapy requires a nuanced discussion between the patient and physician that adequately assesses benefits of prolonged therapy and impact in terms of toxicity, quality of life, and financial cost.

Cost-effectiveness of Lung Cancer Screening in Canada

“…The CRMM does not incorporate oral tyrosine kinase inhibitors into first-line treatment, 45,46 nor does it incorporate maintenance therapy. 47 These newer treatment approaches are effective but costly.…”

Emerging role of EGFR and lung cancer treatments

“…22,23 as a maintenance therapy after first-line, erlotinib has also shown a role in non-progressive patients alone after platinumbased chemotherapy or in combination with bevacizumab after a bevacizumab and cisplatin regimen. 24,25 In addition, wide research on individual patient's tumor biology may be necessary for appropriate targeted therapy. This individual patient approach would finally result in improved PFS and overall survival for the diverse category of lung cancer patients.…”

Low‐dose maintenance gemcitabine‐carboplatin chemotherapy could be an alternative to continuous standard chemotherapy for patients with metastatic urothelial carcinoma

“…The oncological effects of low‐dose maintenance chemotherapy have not been clearly defined. Maintenance chemotherapy can lead to an improvement in progression‐free survival and overall survival in select patents with advanced non‐small cell lung cancer with non‐progressive disease after induction chemotherapy . Maintenance strategies do not appear to have adverse effects on a patient's quality of life, and might delay disease‐related symptoms.…”

“…Maintenance chemotherapy can lead to an improvement in progression-free survival and overall survival in select patents with advanced non-small cell lung cancer with non-progressive disease after induction chemotherapy. 22 Maintenance strategies do not appear to have adverse effects on a patient's quality of life, and might delay disease-related symptoms. Although lower doses and longer intervals would decrease the direct oncological effects, this strategy reduces the risk of severe adverse events, and thereby could facilitate maintenance of nutrition and quality of life.…”