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Maintenance therapy in NSCLC

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Abstract

The current gold standard of care for first-line therapy in patients with nonsmall cell lung cancer (NSCLC) is a platinum-based doublet chemotherapy, which is recommended for a maximum of six cycles. Since the prolongation of the first-line regimen does not translate into improved survival, and most patients experience progression within 3–4 months after first-line therapy, new treatment strategies have been explored to delay disease progression and prolong survival. Maintenance therapy has been proposed as either continuation maintenance with one part of the induction treatment or as switch maintenance with a different agent not used in first-line therapy. There is an accumulating body of evidence that both strategies administered immediately after induction therapy could improve survival in patients with good performance status. In this review, recent results of pivotal studies are summarized, since some studies have shown impressive benefits in terms of survival and their strategy should be considered as a new treatment option in selected patients.

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References

  1. Grossi F, Aita M, Follador A, et al. Sequential, alternating, and maintenance/consolidation chemotherapy in advanced non-small cell lung cancer: a review of the literature. Oncologist. 2007;12:451–64.

    Article  PubMed  CAS  Google Scholar 

  2. Gridelli C, Maione P, Rossi A, et al. Potential treatment options after first-line chemotherapy for advanced NSCLC: maintenance treatment or early second-line? Oncologist. 2009;14(2):137–47.

  3. Smith IE, O’Brien MER, Talbot DC, et al. Duration of chemotherapy in advanced non-small-cell lung cancer: a randomized trial of three versus six courses of mitomycin, vinblastine, and cisplatin. J Clin Oncol. 2001;19:1336–43.

    PubMed  CAS  Google Scholar 

  4. Socinski MA, Schell MJ, Peterman A, et al. Phase III trial comparing a defined duration of therapy versus continuous therapy followed by second-line therapy in advanced-stage IIIB/IV non-small-cell lung cancer. J Clin Oncol. 2002;20:1335–43.

    Article  PubMed  CAS  Google Scholar 

  5. von Plessen C, Bergman B, Andresen O, et al. Palliative chemotherapy beyond three courses conveys no survival or consistent quality-of-life benefits in advanced non-small-cell lung cancer. Br J Cancer. 2006;95:966–73.

    Article  PubMed  CAS  Google Scholar 

  6. Park JO, Kim SW, Ahn JS, et al. Phase III trial of two versus four additional cycles in patients who are nonprogressive after two cycles of platinum based chemotherapy in non-small-cell lung cancer. J Clin Oncol. 2007;25:5233–9.

    Article  PubMed  CAS  Google Scholar 

  7. D’Addario G, Früh M, Reck M, et al., ESMO Guidelines Working Group. Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(Suppl 5):v116–9.

    Article  PubMed  Google Scholar 

  8. Azzoli CG, Temin S, Aliff T, et al., American Society of Clinical Oncology. 2011 focused update of 2009 American Society of Clinical Oncology clinical practice guideline update on chemotherapy for stage IV non-small-cell lung cancer. J Clin Oncol. 2011;29(28):3825–31.

    Article  PubMed  Google Scholar 

  9. Hensing TA, Schell MJ, Lee JH, Socinski MA. Factors associated with the likelihood of receiving second line therapy for advanced non-small cell lung cancer. Lung Cancer. 2005;47:253–9.

    Article  PubMed  Google Scholar 

  10. Belani CP, Barstis J, Perry MC, et al. Multicenter, randomized trial for stage IIIB or IV non small cell lung cancer using weekly paclitaxel and carboplatin followed by maintenance weekly paclitaxel or observation. J Clin Oncol. 2003;15:2933–9.

    Article  Google Scholar 

  11. 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;52:155–63.

    Article  PubMed  Google Scholar 

  12. Belani CP, Waterhouse DM, Ghazal H, et al. Phase III study of maintenance gemcitabine (G) and best supportive care (BSC) versus BSC, following standard combination therapy with gemcitabine-carboplatin (G-Cb) for patients with advanced non-small cell lung cancer (NSCLC). J Clin Oncol. 2010;28:15s (suppl; abstr 7506)

    Google Scholar 

  13. Pérol M, Chouaid C, Pérol D, et al. Randomized, phase III study of gemcitabine or erlotinib maintenance therapy versus observation, with predefined second-line treatment, after cisplatin-gemcitabine induction chemotherapy in advanced non-small-cell lung cancer. J Clin Oncol. 2012;30:3516–24.

    Article  PubMed  Google Scholar 

  14. Zhang X, Zang J, Xu J, et al. Maintenance therapy with continuous or switch strategy in advanced non-small cell lung cancer: a systematic review and meta-analysis. Chest. 2011;140:117–26.

    Article  PubMed  CAS  Google Scholar 

  15. Soon YY, Stockler MR, Askie LM, Boyer MJ. Duration of chemotherapy for advanced non-small-cell lung cancer: a systematic review and meta-analysis of randomized trials. J Clin Oncol. 2009;27(20):3277–83.

    Article  PubMed  Google Scholar 

  16. Paz-Ares L, De Marinis F, Dediu M, et al. Maintenance therapy with pemetrexed plus best supportive care versus placebo plus best supportive care after induction therapy with pemetrexed plus cisplatin for advanced non-squamous non-small-cell lung cancer (PARAMOUNT): a double-blind, phase 3, randomised controlled trial. Lancet Oncol. 2012;13:247–55.

    Article  PubMed  CAS  Google Scholar 

  17. Paz-Ares L, De Marinis F, Dediu M, et al. PARAMOUNT: final overall survival (OS) results of the phase III study of maintenance pemetrexed (pem) plus best supportive care (BSC) versus placebo (plb) plus BSC immediately following induction treatment with pem plus cisplatin (cis) for advanced nonsquamous (NS) non-small cell lung cancer (NSCLC). J Clin Oncol. 2012;30 (suppl; abstr LBA7507).

  18. Dansin E, Tsai CM, Pavlakis N, et al., on behalf of the MO19390 (SAiL) Study Group. Safety and efficacy of first-line bevacizumab (bv)-based therapy in advanced non-small cell lung cancer (nsclc): results of the SAIL study (MO 19390) ECCO15/34th ESMO Multidisciplinary Congress Abstract Book. EJC Suppl. 2009;7(2):556 (poster 9168).

    Google Scholar 

  19. Sandler A, Gray R, Perry MC, et al. Paclitaxel-carboplatin alone or with bevacizumab for non-smallcell lung cancer. N Engl J Med. 2006;355:2542–50.

    Article  PubMed  CAS  Google Scholar 

  20. Reck M, von Pawel J, Zatloukal P, et al. Phase III trial of cisplatin plus gemcitabine with either placebo or bevacizumab as first-line therapy for nonsquamous non-small-cell lung cancer: AVAil. J Clin Oncol. 2009;27:1227–34.

    Article  PubMed  CAS  Google Scholar 

  21. Pirker R, Pereira JR, Szczesna A, et al. Cetuximab plus chemotherapy in patients with advanced non-small-cell lung cancer (FLEX): an open-label randomised phase III trial. Lancet. 2009;373:1525–31.

    Article  PubMed  CAS  Google Scholar 

  22. Barlesi F, de Castro J, Dvornichenko V, et al. AVAPERL (MO22089): final efficacy outcomes for patients (pts) with advanced non-squamous non-small cell lung cancer (nsNSCLC) randomised to continuation maintenance (mtc) with bevacizumab (bev) or bev + pemetrexed (pem) after firstline (1L) bev–cisplatin (cis)–pem treatment (Tx). Eur J Cancer. 2011;47:16 (abstr 34LBA).

    Article  Google Scholar 

  23. Ciuleanu T, Brodowicz T, Zielinski C, et al. Maintenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer: a randomised, double-blind, phase 3 study. Lancet. 2009;374(9699):1432–40.

    Article  PubMed  CAS  Google Scholar 

  24. Fidias PM, Dakhil SR, Lyss AP, et al. Phase III study of immediate compared with delayed docetaxel after front-line therapy with gemcitabine plus carboplatin in advanced non-small-cell lung cancer. J Clin Oncol. 2009;27:591–8.

    Article  PubMed  CAS  Google Scholar 

  25. Cappuzzo F, Ciuleanu T, Stelmakh L, et al. Erlotinib as maintenance treatment in advanced non-small-cell lung cancer: a multicentre, randomised, placebo-controlled phase 3 study. Lancet Oncol. 2010;11:521–9.

    Article  PubMed  CAS  Google Scholar 

  26. Miller VA, O’Connor P, Soh C, et al., for the ATLAS Investigators. A randomized, double-blind, placebo-controlled, phase IIIb trial (ATLAS) comparing bevacizumab (B) therapy with or without erlotinib (E) after completion of chemotherapy with B for first-line treatment of locally advanced, recurrent, or metastatic non-small cell lung cancer (NSCLC). J Clin Oncol. 2009;27:18s (suppl; abstr LBA8002).

    Article  Google Scholar 

  27. Kabbinavar FF, Miller VA, Johnson BE, et al., on behalf of the ATLAS Investigators. Overall survival (os) in atlas, a phase iiib trial comparing bevacizumab (b) therapy with or without erlotinib (e) after completion of chemotherapy (chemo) with b for first-line t reatment of locally advanced, recurrent, or metastatic non-small cell lung cancer (nsclc). J Clin Oncol. 2010;28:15s (suppl; abstr 7526).

    Google Scholar 

  28. Gaafar RM, Surmont VF, Scagliotti GV, et al., EORTC Lung Cancer Group and the Italian Lung Cancer Project. A double-blind, randomised, placebo-controlled phase III intergroup study of gefitinib in patients with advanced NSCLC, non-progressing after first line platinum-based chemotherapy (EORTC 08021/ILCP 01/03). Eur J Cancer. 2011;47(15):2331–40.

    Article  PubMed  CAS  Google Scholar 

  29. Zhang L, Ma S, Song X, et al., INFORM investigators. Gefitinib versus placebo as maintenance therapy in patients with locally advanced or metastatic non-small-cell lung cancer (INFORM; C-TONG 0804): a multicentre, double-blind randomised phase 3 trial. Lancet Oncol. 2012;13(5):466–75.

    Article  PubMed  CAS  Google Scholar 

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The author declares that there is no actual or potential conflicts of interest in relation to this article.

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Correspondence to Thomas Brodowicz MD.

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Brodowicz, T. Maintenance therapy in NSCLC. memo 6, 14–18 (2013). https://doi.org/10.1007/s12254-012-0062-8

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  • DOI: https://doi.org/10.1007/s12254-012-0062-8

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