title: Single agent maintenance therapy for advanced stage non-small cell lung cancer: a meta-analysis.
abstract: BACKGROUND
  Maintenance therapy is a new treatment paradigm for advanced non-small cell lung cancer (NSCLC). We conducted a meta-analysis of randomized studies with single agent maintenance therapy.
  
  
  METHODS
  An electronic literature search of public databases (MEDLINE, EMBASE, Cochrane library) and manual search of relevant conference proceedings was performed. A formal meta-analysis was conducted using Comprehensive Meta Analysis software (Version 2.0). Outcome data were pooled and reported as hazard ratio (HR). The primary outcome of interest was overall survival (OS) and secondary outcome was progression free survival (PFS).
  
  
  RESULTS
  Twelve studies were included (5 meeting abstracts, 7 full manuscripts) with a total of 4286 patients (maintenance arm/control arm - 2449/1837, median age 61 years, males - 69%). The OS (HR 0.86, 95% confidence intervals [CI] 0.80-0.92; P=0.0003) and PFS (HR 0.80, 95% CI 0.77-0.84; P<0.0001) were superior with maintenance therapy. 'Switch' maintenance was associated with significant OS and PFS improvement (OS HR 0.84, 95% CI 0.77-0.91; P=0.00026; PFS HR 0.62, 95% CI 0.57-0.67; P<0.0001). Despite a modest improvement in PFS (HR 0.90, 95%CI 0.85-0.95; P=0.007), "continuation" maintenance was not associated with survival benefit (HR 0.927, 95%CI 0.78-1.09; P=0.33). Improvements in OS and PFS were observed with both EGFR-targeted agents (HR 0.83, 95% CI 0.74-0.92; P=0.004; HR 0.64, 95% CI 0.58-0.71 P<0.0001) and cytotoxic agents (HR 0.89, 95% CI 0.80-0.98; P=0.018; HR 0.85, 95% CI 0.80-0.89; P<0.0001).
  
  
  CONCLUSIONS
  Single agent maintenance therapy improves overall survival, though statistical significance was only noted with 'switch' maintenance.
authors.affiliation: Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute of Emory University, Atlanta, GA, USA.
authors.forename: Madhusmita
authors.initials: M
authors.lastname: Behera
authors.forename: Taofeek K
authors.initials: TK
authors.lastname: Owonikoko
authors.forename: Zhengjia
authors.initials: Z
authors.lastname: Chen
authors.forename: Scott A
authors.initials: SA
authors.lastname: Kono
authors.forename: Fadlo R
authors.initials: FR
authors.lastname: Khuri
authors.forename: Chandra P
authors.initials: CP
authors.lastname: Belani
authors.forename: Suresh S
authors.initials: SS
authors.lastname: Ramalingam
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D060046:Maintenance Chemotherapy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome