Abstract
Maintenance therapy is emerging as a treatment strategy in the management of advanced non small cell lung cancer (NSCLC). Initial trials addressing the question of duration of combination chemotherapy failed to show any overall survival benefit for the prolonged administration over a fixed number of cycles with an increased risk for cumulative toxicity. Nowadays several agents with different ways of administration and a different pattern of toxicity have been formally investigated in the maintenance setting. Maintenance strategies include continuing with an agent already present in the induction regimen or switching to a different one. Taking into consideration that no comparative trials of maintenance with different chemotherapy drugs or targeted agents have been conducted, the choice and the duration of maintenance agents is largely empirical. Furthermore, it is still unknown and it remains an open question if this approach needs to be proposed to every patient in the case of partial/complete response or stable disease after the induction therapy. Here, we critically review available data on maintenance treatment, discussing the possibility to tailor the right treatment to the right patient, in an attempt to optimize costs and benefits of an ever-growing panel of different treatment options.
Highlights
Lung cancer is the leading cause of cancer mortality in USA and worldwide more than one million people die from this disease every year: the overall 5-year relative survival rate measured by the Surveillance Epidemiology and End Results program in USA is 15.8% [1]
Another phase III trial comparing gemcitabine versus best supportive care (BSC) as maintenance therapy for patients not progressing after 4 cycles of gemcitabine/carboplatin induction was recently presented
In a third trial employing gemcitabine or erlotinib maintenance after 4 cycles of gemcitabine/cisplatin induction and with a preplanned II-line treatment option, PFS by independent review was significantly prolonged by both G (HR 0.51, 95% CI 0.39-0.66) and E (HR 0.83, 95% CI 0.73-0.94), as compared to O
Summary
Lung cancer is the leading cause of cancer mortality in USA and worldwide more than one million people die from this disease every year: the overall 5-year relative survival rate measured by the Surveillance Epidemiology and End Results program in USA is 15.8% [1]. For advanced NSCLC the options to continue treatment after first-line induction include: 1) continuing induction therapy for a fixed number of additional cycles over the standard or, when possible, until progression; 2) continuing only the third-generation non-platinum compound used in the induction regimen; 3) switching to a different agent after induction therapy. The most important difference between the two arms during the maintenance phase was the need for red blood cells transfusions (20% in the gemcitabine arm versus 6.3% in the BSC arm, p = 0.018) [19] Another phase III trial comparing gemcitabine versus BSC as maintenance therapy for patients not progressing after 4 cycles of gemcitabine/carboplatin induction was recently presented.
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