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Re-examination of Maintenance Therapy in Non-Small Cell Lung Cancer with the Advent of New Anti-cancer Agents

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Abstract

Metastatic non-small cell lung cancer remains a disease with a high annual incidence and annual mortality worldwide, with limitations in first-line treatment past a fixed amount of platinum doublet chemotherapy for patients that do not harbor a targetable genetic abnormality such as an EGFR mutation or ALK gene rearrangement. Previous attempts to extend first-line treatment past 4–6 cycles of conventional cytotoxic chemotherapy have been disappointing, resulting in diminished quality of life and increased toxicity without improvement of progression-free or overall survival. Several advances in third-generation chemotherapy and targeted agents have generated a renewed interest in maintenance therapy, with several randomized phase III trials reporting a significant improvement in progression-free and overall survival with manageable toxicity profiles. The availability of new chemotherapy agents, tyrosine kinase inhibitors, and immunotherapy agents with a more tolerable or nonoverlapping toxicity profile have resulted in improvements in progression-free survival and median overall survival in maintenance settings with specific agents such as pemetrexed and erlotinib. Patients who are responding to first-line therapy, have not suffered a detrimental decrease in quality of life or performance status, and understand the risks and benefits of further immediate chemotherapy should be considered for maintenance treatment.

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Acknowledgments

R.C. Doebele has received research grants from Eli Lilly & Co. and ImClone Systems for projects unrelated to the subject matter of this review. E.M. Berge has no conflict of interest to disclose. No outside funding sources were used for the preparation of this manuscript.

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    Eamon M. Berge & Robert C. Doebele

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Berge, E.M., Doebele, R.C. Re-examination of Maintenance Therapy in Non-Small Cell Lung Cancer with the Advent of New Anti-cancer Agents. Drugs 73, 517–532 (2013). https://doi.org/10.1007/s40265-013-0032-4

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