Maintenance for non-small cell lung cancer – pro
Continuation, or “maintenance,” therapy in advanced NSCLC is of some but limited utility for non-small l ell lung cancer.. Socinski and colleagues found that 6 cycles of paclitaxel plus carboplatin produced the similar response rate, survival benefit, and quality of life as continuation of combination therapy past 4 cycles, with greater neurotoxicity occurring in the continuation arm.3Proceeding with single-agent maintenance therapy as an alternative to the continuation of more toxic doublet therapy also failed to show survival benefit in multiple trials of agents including gemcitabine and docetaxel .4-6 A subsequent meta-analysis published in 2009 revealed that continuation therapy produced significant improvement in PFS, however, overall survival was only slightly improved (HR, 0.92; P = .03) . Agents that have been shown to improve survival when administered as maintenance therapy include bevacizumab and pemetrexed, and possibly erlotinib, but not Taxotere.
Brodowicz T, Krzakowski M, Zwitter M, et al. Cisplatin and gemcitabine first-line chemotherapy followed by maintenance gemcitabine or best supportive care in advanced non-small cell lung cancer: a phase III trial. Lung Cancer. 2006;52(2):155-163.
Fidias PM, Dakhil SR, Lyss AP, et al. Phase III study of immediate compared with delayed docetaxel after frontline therapy with gemcitabine plus carboplatin in advanced non-small cell lung cancer. J Clin Oncol. 2009;27(4):591-598.
Barlesi F, Scherpereel A, Rittmeyer A, et al. Randomized phase III trial of maintenance bevacizumab with or without pemetrexed after first-line induction with bevacizumab, cisplatin, and pemetrexed in advanced nonsquamous non-small cell lung cancer: AVAPERL (MO22089). J Clin Oncol. 2013;31(24):3004-3011.
Barlesi F, Scherpereel, A, Gorbunova B, et al. Maintenance bevacizu
mab-pemetrexed after first-line cisplatin-pemetrexed-bevacizumab for advanced nonsquamous nonsmall-cell lung cancer: updated survival analysis of the AVAPERL (MO22089) randomized phase III trial. Ann Oncol. 2014;25(5):1044-1052. – See more at: http://www.onclive.com/publications/contemporary-oncology/2015/april-2015/maintenance-strategies-after-initial-chemotherapy-for-non-small-cell-lung-cancer?p=3#sthash.5IMcX8Q2.dpuf