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Les traitements de maintenance dans les cancers bronchiques non à petites cellules métastatiques en 2012

Maintenance therapy in advanced non-small cell lung cancer in 2012

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Oncologie

Abstract

Treatment of advanced non-smallcell lung cancer is usually based on several lines of therapy separated by treatment-free intervals, in which each new line is started when tumor progression is detected. The maintenance strategy consists of continuing an appropriate, well-tolerated treatment immediately after the end of first-line chemotherapy, in order to maintain the initial therapeutic benefit and to avoid rapid clinical deterioration that would rule out further treatment. Maintenance can use either a non-platinum component of induction chemotherapy defining ‘continuation maintenance’ or initiation of a new agent consisting in ‘switch maintenance’. Clinical trials show that maintenance therapy with pemetrexed or erlotinib provides a significant clinical benefit in terms of disease control and survival. Maintenance therapy is an important option in first-line treatment of non-small cell lung cancer but more reliable criteria is needed to identify the patientsmost likely to benefit from either continuation or switch maintenance.

Résumé

Le traitement des cancers bronchiques non à petites cellules avancés est fondé sur l’administration de plusieurs lignes de traitement, déterminées par la progression de la maladie, et séparées par des intervalles libres de tout traitement. La stratégie de maintenance consiste en la poursuite d’un traitement adapté, peu toxique, dès la fin de la chimiothérapie de première ligne dans le but de maintenir le bénéfice thérapeutique obtenu et d’éviter une progressionrapide de la maladie inaccessible à l’administration d’un traitement ultérieur. Il peut s’agir soit d’une composante du traitement d’induction, définissant la maintenance de continuation, soit d’un traitement différent, constituant une “switch” maintenance. Les essais conduits montrent que la stratégie de maintenance prolonge la durée du contrôle de la maladie et améliore la survie de manière cliniquement significative avec le pemetrexed et l’erlotinib. La maintenance est devenue une option thérapeutique importante en première ligne, avec la nécessité de préciser les critères permettant la sélection des patients bénéficiant le plus de chacune des deux stratégies de maintenance.

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  1. Département de cancérologie médicale, centre Léon-Bérard, F-69373, Lyon cedex 08, France

    M. Pérol

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Pérol, M. Les traitements de maintenance dans les cancers bronchiques non à petites cellules métastatiques en 2012. Oncologie 14, 297–304 (2012). https://doi.org/10.1007/s10269-012-2156-7

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  • DOI: https://doi.org/10.1007/s10269-012-2156-7

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