Abstract
Treatment of lung cancer had evolved during the last decade with the introduction of new chemotherapeutic regimens and targeted therapies. However, the maximum benefit reached after first-line therapy is limited by the cumulative toxicity of platinum drugs and the subsequent deterioration in performance status in a high percentage of patients who end up receiving not more than one line of treatment. Maintenance therapy had been introduced and evaluated in many large randomized trials showing a delay in tumor progression and an improvement in overall survival. This effective strategy should be taken into account when discussing the initial treatment plan and tailored according to the preferences of both patients and physicians.
Highlights
Standard first-line treatment for patients who are negative for the EGFR mutation and ALK rearrangement consists of platinumbased chemotherapy [1]
The limited benefit from extending platinum-based chemotherapy beyond four cycles as well as the cumulative toxicities of these regimens leading to worsening of the quality of life (QoL) [2,3,4] had led to the re-emergence of a relatively new concept based on maintaining the response in patients who attain tumor control during first-line induction treatment
Many large randomized studies have shown that maintenance therapy is associated with a delay in tumor progression and an improvement in overall survival, prolonging therapy in a palliative intent significantly increases the burden of medical interventions to a patient, prohibits the patient from having an often desired treatment holiday and may increase treatment related toxicities, which may have a detrimental impact on QoL
Summary
Standard first-line treatment for patients who are negative for the EGFR mutation and ALK rearrangement consists of platinumbased chemotherapy [1]. Many large randomized studies have shown that maintenance therapy is associated with a delay in tumor progression and an improvement in overall survival, prolonging therapy in a palliative intent significantly increases the burden of medical interventions to a patient, prohibits the patient from having an often desired treatment holiday and may increase treatment related toxicities, which may have a detrimental impact on QoL. This mini review will expose the issues related to maintenance therapy and discuss a personalized approach to the implementation of such strategies in clinical practice.
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