Extended-duration therapy in advanced non-small-cell lung cancer: promise and pitfalls.
For many years, the cornerstone of treatment for non-small-cell lung cancer (NSCLC) has been third-generation platinum-based chemotherapy. Unfortunately, clinical outcomes with the use of this approach have remained poor, with median survival times of only 8-13 months. In an attempt to improve survival, several therapeutic strategies have recently been investigated, including extended-duration chemotherapy. Although historically maintenance chemotherapy in NSCLC has resulted in less-than-optimal outcomes and there has been a recent surge in interest with this treatment modality. This has been in part because of the strategy of the early delivery of a non-cross-resistant agent after platinum chemotherapy, now termed switch maintenance therapy. Results from several recent phase III trials using this strategy are shifting the treatment paradigm of patients with advanced-stage NSCLC. Despite more favorable outcomes demonstrated with this strategy, study designs and reported results have not been without critique. Here, we review all published extended-duration chemotherapy strategies in NSCLC and seek to clarify outstanding issues as they relate to more recent approaches using this strategy.
Beth Israel Hospital, New York, NY 10003, USA. belevy@chpnet.org
Benjamin
B
Levy
Alexander
A
Drilon
Karleung
K
Siu
Michael
M
Grossbard
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D004334:Drug Administration Schedule; D019008:Drug Resistance, Neoplasm; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017671:Platinum Compounds / Q000008:administration & dosage; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D017671:Platinum Compounds