Personalized Choice of Maintenance Therapies in Non-Small-Cell Lung Cancer

Abstract

Platinum-based combinations currently remain the preferred approach in the first-line setting 5,6 . Further studies have also established a role for second-line and, in some instances, third-line therapy with agents such as docetaxel, pemetrexed, and erlotinib. These advances have resulted in median survivals of 10-12 months in contemporary studies.Although second-line therapies have improved overall survival, up to 50% of patients completing first-line treatment become ineligible for further treatment, mostly because of significant tumour progression or rapid decline in performance status (or both). This reality has pushed many investigators to study earlier use of second-line therapy in the form of maintenance therapy. First-line maintenance therapy is defined in the setting of patients not experiencing progression after a first-line platinum-containing regimen. Some investigators have studied the prolonged use of the platinum partner from the firstline regimen in what has been called "continuation maintenance"; others have studied the use of a noncross-resistant agent after induction, which has been termed "switch maintenance" 7 . Clinically significant results generated from many studies have raised the question of personalized approaches based on clinical, pathologic, and molecular features of the cancer.Recognizing the importance of the pathologic and molecular features of lung cancer, the Canadian consensus biomarker group recently recommended that histologic subtyping of nsclc be performed in every case 8 . For example, non-squamous histology was shown to be predictive of superiority for the pemetrexed arm over the standard arm in three large randomized studies 6,9 . Prediction of serious bleeding toxicity with bevacizumab in squamous cell lung cancer patients was also suggested in an early phase ii trial, leading to the eventual exclusion of patients with squamous histology from most trials testing that drug 10,11 . Thus, the distinction between squamous and non-squamous histology has become fundamental in the management of nsclc.Similarly, the identification of specific "druggable" targets such as mutated EGFR and overexpressed ABSTRACTLung cancer has become a leading cause of cancerrelated death in the world. Patient survival has improved with the introduction of new chemotherapy regimens and targeted drugs, but still, because of tumour progression or deterioration in performance status, a high percentage of patients do not receive more than one line of treatment. Given this situation, studies of maintenance therapies have begun, with results that have led to the clinical use of various drugs in a maintenance scenario. Additionally, results obtained in various clinical trials have raised the question of personalized approaches based on the clinical, pathologic, and molecular features of the cancer-not only in the initial approach, but also in the context of maintenance. Overall, the survival benefit seen with maintenance treatment has introduced a new therapy option that should be considered and discu...

Treatment Decisions for Advanced Non-Squamous Non-Small Cell Lung Cancer: Patient and Physician Perspectives on Maintenance Therapy

“…Previous studies have identified response to first-line therapy, histology, physical functioning, and the presence of biomarkers as being influential to physicians’ MT recommendations [ 12 – 18 ]. Our study also identified response to first-line treatment as a key factor for physicians; however, surprisingly and contrary to NCCN guidelines, disease progression was not always a deterrent to a MT recommendation, based on the hypothetical profiles presented to physicians.…”

Epidemiological changes in the histological subtypes of 35,018 non-small-cell lung cancer cases in Brazil

“…This may represent the future for other histological subtypes such as SCC. Therefore, in addition to clinical epidemiological data, future molecular epidemiological data on LC in Brazil will be required to improve the balance of costs and to meet oncological demands [7,12].…”

“…Changes in histological patterns in smokers and males from predominantly SCC to predominantly ACA, were reported in several countries [5,6,8,[9][10][11]. The histological type plays a role in defining the appropriate type of systemic treatment that should be implemented with the largest therapeutic arsenal being available for ACA; mainly in terms of targeted chemotherapy [7].…”