Tarceva for Maintenance in Non-small Cell Lung Cancer

Tarceva (erlotinib) is FDA approved for non-small cell lung cancer after standard chemo has failed. Older studies showed that it does not contribute to chemotherapy in first-line. It is being studied for first line therapy of lung cancer instead of chemotherapy. This drug has been studied primarily in stage IV, when it has spread but recently it has been also studied, for maintenance, once treatment with chemotherapy had stopped. Maintenance means that after a complete response, that is no evidence of remaining cancer, or a good partial response, the patient can be maintained on a drug to improve the chance of cure or to postpone cancer’s return. Studies, such as the Saturn trial, have been encouraging for maintenance and suggest prolongation of time without progression of cancer (PFS) but not overall survival. Only overall survival translates into a high chance of cure. NICE, a European body that composes guidelines, in 2011 did not recommend routine use of Tarceva for maintenance, because  the independent Appraisal Committee felt that there was too much uncertainty about the amount of extra time or overall survival gain expected from the treatment and that based on the evidence available erlotinib was not considered value for money. On the other hand, in the USA Erlotinib is recommended as an option in the NCCN Guidelines® for maintenance therapy in advanced non-small cell lung cancer (NSCLC) based on the results of the aforementioned SATURN trial.

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