title: Maintenance therapy with continuous or switch strategy in advanced non-small cell lung cancer: a systematic review and meta-analysis.
abstract: BACKGROUND
  Maintenance therapy for patients with non-small cell lung cancer (NSCLC) has gained extensive interest. Varying results for this treatment underpin the need for a synthesis of evidence.
  
  
  METHODS
  Trials investigating maintenance therapy with either a continuous or a switch strategy for patients with nonprogressing NSCLC compared with placebo or observation were identified. The primary outcome was overall survival (OS), and secondary outcomes included progression-free survival (PFS) and toxicity.
  
  
  RESULTS
  Eight trials of 3,736 patients were included in the analysis. Switch maintenance therapy substantially improved OS compared with placebo or observation (hazard ratio [HR], 0.85; 95% CI, 0.79-0.92; P < .001). A similar trend of improved OS was found in continuous maintenance therapy, despite lacking statistical significance (HR, 0.88; 95% CI, 0.74-1.04; P = .124). The interaction test suggested that the difference in OS between the two maintenance strategies was not statistically significant (P = .777). Clinically substantial and statistically significant improvement in PFS was found with both maintenance strategies (switch maintenance therapy HR, 0.67; 95% CI, 0.57-0.78; continuous maintenance therapy HR, 0.53; 95% CI, 0.43-0.65; interaction P = .128). Subgroup analyses revealed no statistically significant differences in OS or PFS between switch maintenance therapy with cytotoxic agents and that with tyrosine kinase inhibitor agents. Toxicity was greater in maintenance therapy.
  
  
  CONCLUSIONS
  Maintenance therapy with either a continuous or a switch strategy significantly increases OS and PFS compared with placebo or observation. However, the benefits must be balanced against toxicity.
authors: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors: Xinji
authors: X
authors: Zhang
authors: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors: Jiajie
authors: J
authors: Zang
authors: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors: Jinfang
authors: J
authors: Xu
authors: Respiratory Department, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors: Chong
authors: C
authors: Bai
authors: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors: Yingyi
authors: Y
authors: Qin
authors: Department of Medical Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors: Ke
authors: K
authors: Liu
authors: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors: Cheng
authors: C
authors: Wu
authors: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors: Meijing
authors: M
authors: Wu
authors: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors: Qian
authors: Q
authors: He
authors: Tumor Immunology and Gene Therapy Center, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors: Shanshan
authors: S
authors: Zhang
authors: Tumor Immunology and Gene Therapy Center, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors: Lixin
authors: L
authors: Wei
authors: Department of Health Statistics, Second Military Medical University, Shanghai, China. Electronic address: hejia63@yahoo.com.
authors: Jia
authors: J
authors: He
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality; D002681:China / Q000453:epidemiology; D018572:Disease-Free Survival; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality; D017410:Practice Guidelines as Topic; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D047428:Protein Kinase Inhibitors