Maintenance therapy for advanced non-small-cell lung cancer: Switch versus continuation

Introduction : The concept of maintenance therapy in lung cancer has stirred a great deal of interest over the last decade. Several randomized studies have been conducted to find out the usefulness of maintenance therapies for advanced non-small-cell lung cancer (NSCLC). Areas covered : This article reviews the major benchmark clinical trials and strategies in the field of maintenance chemotherapy in advanced NSCLC. The two strategies used in maintenance therapy are: i) continuation maintenance - continuation of one of the initial treatments; and ii) switch maintenance - switching to a different agent not administered as initial treatment. Both chemotherapeutic and molecular targeted agents have been studied in the maintenance setting. These include docetaxel, gemcitabine, pemetrexed, bevacizumab, erlotinib and gefitinib. This paper discusses the relevant clinical trials using these agents and the two different strategies in the maintenance therapy in advanced NSCLC. Expert opinion : Despite some controversy regarding the choice or the timing of the maintenance therapy, most of the clinical trials have demonstrated a significant improvement of progression-free survival, translating to a survival benefit with pemetrexed and erlotinib. The approval of pemetrexed and erlotinib by the FDA has certainly shifted the pendulum towards maintenance therapy.