title: Re-examination of maintenance therapy in non-small cell lung cancer with the advent of new anti-cancer agents.
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.
authors.affiliation: Division of Medical Oncology, Department of Medicine, University of Colorado, Mail Stop 8117, 12801 E. 17th Avenue, Room 8105, Aurora, CO 80045, USA. Eamon.Berge@ucdenver.edu
authors.forename: Eamon M
authors.initials: EM
authors.lastname: Berge
authors.forename: Robert C
authors.initials: RC
authors.lastname: Doebele
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D060046:Maintenance Chemotherapy / Q000379:methods* / Q000639:trends; D016032:Randomized Controlled Trials as Topic / Q000379:methods
chemical_list: D000970:Antineoplastic Agents