Generic placeholder image

Current Cancer Therapy Reviews


ISSN (Print): 1573-3947
ISSN (Online): 1875-6301

Review Article

Do we Need Maintenance Chemotherapy in Advanced NSCLC in the Era of Immune and Targeted Therapy?

Author(s): Ahmed Nagy*, Omar Abdel Rahman, Heba Abdullah and Ahmed Negida

Volume 15 , Issue 1 , 2019

Page: [50 - 55] Pages: 6

DOI: 10.2174/1573394714666180417160205

Price: $65


Background: Although well established for the effective management of hematologic cancers, maintenance chemotherapy has only been recently incorportated as a treatment paradigm for advanced non–small-cell lung cancer. Maintenance chemotherapy aims to prolong a clinically favorable response state achieved after finishing induction therapy which is usually predefined in number before startng treatment. There are 2 modalities for maintenance therapy; continuation maintenance (involving a non-platinum component which was a part of the induction protocol or a targeted agent) and switch maintenance therapy (utilizing a new agent which was not a part of the induction regimen).

Methods: The purpose of this article is to review the role of maintenance therapy in the treatment of advanced Non-Small Cell Lung Cancer (NSCLC) and provide a brief overview about induction chemotherapy in NSCLC to address the basis of maintenance therapy as a treatment option. We will also compare the impact of maintenance chemotherapy with the now evolving role of immunotherapy in NSCLC.

Results: There have been 4 maintenance studies to date showing prolonged PFS and OS with statistical significance. However, Three out of the four studies (ECOG4599, JMEN, and PARAMOUNT) did not report tumor molecular analysis. As regard Immunotherapy, current data is in favour of strongly an increasing role for immunotherapy in NSCLC.

Conclusion: Maintenance therapy in NSCLC continues to be an important therapeutic line to improve outcome in patients with metastatic and recurrent disease.

Keywords: Chemotherapy, NSCLC, targeted therapy, lung cancer, overall survival, anticancer agents.

Graphical Abstract
Dearing KR, Sangal A, Weiss GJ. Maintaining clarity review of maintenance therapy in non-small cell lung cancer. World J Clin Oncol 2014; 5(2): 103-13.
World Health Organization. World Cancer Report 2014. 2014. pp. Chapter 1.1. ISBN 9283204298.
Brodowicz T, Krzakowski M, Zwitter M, et al. Cisplatin and gemcitabine first-line chemotherapy followed by maintenance gemcitabine or best supportive care in advanced non-small cell lung cancer a phase III trial. Lung Cancer 2006; 52(2): 52155-63.
Gerber DE, Schiller JH. Maintenance chemotherapy for advanced non–small-cell lung cancer new life for an old idea. J Clin Oncol 2013; 31(8): 1009-20.
Pérol M. Maintenance therapy in non-small-cell lung cancer - review of rationale, clinical need and available data. Eur Resp Dis 2010; 6(1): 70-5.
Klement G, Baruchel S, Rak J, et al. Continuous low-dose therapy with vinblastine and VEGF receptor-2 antibody induces sustained tumor regression without overt toxicity. J Clin Invest 2000; 105(8): R15-24.
Bassan F, Peter F, Houbre B, et al. Adherence to oral antineoplastic agents by cancer patients definition and literature review. Eur J Cancer Care (Engl) 2014; 23(1): 2322-35.
Cullen MH, Billingham LJ, Woodroffe CM, et al. Mitomycin, ifosfamide, and cisplatin in unresectable non-small-cell lung cancer Effects on survival and quality of life. J Clin Oncol 1999; 17(10): 173188-94.
Dancey J, Shepherd FA, Gralla RJ, et al. Quality of life assessment of second-line docetaxel versus best supportive care in patients with non-small-cell lung cancer previously treated with platinum-based chemotherapy results of a prospective, randomized phase III trial. Lung Cancer 2004; 43(2): 43183-94.
Cappuzzo F, Ciuleanu T, Stelmakh L, et al. Erlotinib as maintenance treatment in advanced non-small-cell lung cancer a multicentre, randomised, placebo-controlled phase 3 study. Lancet Oncol 2010; 11(6): 11521-9.
Fidias PM, Dakhil SR, Lyss AP, et al. Phase III study of immediate compared with delayed docetaxel after front-line therapy with gemcitabine plus carboplatin in advanced non-small-cell lung cancer. J Clin Oncol 2009; 27(4): 27591-8.
Smith IE, O’Brien ME, Talbot DC, et al. Duration of chemotherapy in advanced non-small-cell lung cancer a randomized trial of three versus six courses of mitomycin, vinblastine, and cisplatin. J Clin Oncol 2001; 19: 1336-43.
Socinski MA, Schell MJ, Peterman A, et al. Phase III trial comparing a defined duration of therapy versus continuous therapy followed by second-line therapy in advanced-stage IIIB/IV non-small-cell lung cancer. J Clin Oncol 2002; 20: 1335-43.
Klein R, Wielage R, Muehlenbein C, et al. Cost-effectiveness of pemetrexed as first-line maintenance therapy for advanced nonsquamous non-small cell lung cancer. J Thorac Oncol 2010; 5(8): 51263-72.
Nuijten MJ, de Castro Carpeño J, Chouaid C, et al. A cross-market cost comparison of erlotinib versus pemetrexed for first-line maintenance treatment of patients with locally advanced or metastatic non-small-cell lung cancer. Lung Cancer 2012; 76(3): 76465-71.
Lindeman NI, Cagle PT, Beasley MB, et al. Molecular testing guideline for selection of lung cancer patients for EGFR and ALK tyrosine kinase inhibitors guideline from the college of american pathologists, international association for the study of lung cancer, and association for molecular pathology. J Thorac Oncol 2013; 8(7): 8823-59.
Pardoll D. The blockade of immune checkpoints in cancer immunotherapy. Nat Rev Cancer 2012; 12: 252-64.
Schreiber R, Old L, Smyth M. Cancer immunoediting integrating immunity’s roles in cancer suppression and promotion. Science 2011; 331: 1565-70.
Wrangle J, Wang W, Koch A, et al. Alterations of immune response of non-small cell lung cancer with azacytidine. Oncotarget 2013; 4: 2067-79.
Sundar R, Soong R, Cho B, et al. Immunotherapy in the treatment of non-small cell lung cancer. Lung Cancer 2014; 85: 101-9.
Westeel V, Quoix E, Moro-Sibilot D, et al. Randomized study of maintenance vinorelbine in responders with advanced non-small-cell lung cancer. J Natl Cancer Inst 2005; 97: 499-506.
Ciuleanu T, Brodowicz T, Zielinski C, et al. Maintenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer a randomised, double-blind, phase 3 study. Lancet 2009; 374(9699): 3741432-40.
Patel JD, Socinski MA, Garon EB, et al. Point Break a randomized phase III study of pemetrexed plus carboplatin and bevacizumab followed by maintenance pemetrexed and bevacizumab versus paclitaxel plus carboplatin and bevacizumab followed by maintenance bevacizumab in patients with stage IIIB or IV nonsquamous non-small-cell lung cancer. J Clin Oncol 2013; 31(34): 314349-57.
Pirker R, Pereira JR, Szczesna A, et al. Cetuximab plus chemotherapy in patients with advanced non-small-cell lung cancer (FLEX) an open-label randomised phase III trial. Lancet 2009; 373(9674): 3731525-31.
Reck M, von Pawel J, Zatloukal P, et al. Phase III trial of cisplatin plus gemcitabine with either placebo or bevacizumab as first-line therapy for nonsquamous non-small-cell lung cancer AVAil. J Clin Oncol 2009; 27(8): 271227-34.
Paz-Ares LG, de Marinis F, Dediu M, et al. PARAMOUNT Final overall survival results of the phase III study of maintenance pemetrexed versus placebo immediately after induction treatment with pemetrexed plus cisplatin for advanced nonsquamous non-small-cell lung cancer. J Clin Oncol 2013; 31(23): 312895-902.
Lynch TJ, Patel T, Dreisbach L, et al. Cetuximab and first-line taxane/carboplatin chemotherapy in advanced non-small-cell lung cancer results of the randomized multicenter phase III trial BMS099. J Clin Oncol 2010; 28(6): 28911-7.
Brahmer J, Reckamp KL, Baas P, et al. Nivolumab versus Docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med 2015; 373(2): 123-35.
Borghaei H, Paz-Ares L, Horn L, et al. Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med 2015; 373(17): 1627-39.
Pérol M, Chouaid C, Pérol D, et al. Randomized, phase III study of gemcitabine or erlotinib maintenance therapy versus observation, with predefined second-line treatment, after cisplatin-gemcitabine induction chemotherapy in advanced non-small-cell lung cancer. J Clin Oncol 2012; 30(28): 303516-24.

Rights & Permissions Print Export Cite as
© 2022 Bentham Science Publishers | Privacy Policy