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Maintenance therapies in advanced non-small-cell lung cancer

Daniel J Lebovic, Alberto Chiappori and Jhanelle Gray

Advanced non-small-cell lung cancer is treated with upfront platinum doublet chemotherapy, which produces moderate survival improvements. Unfortunately, many patients quickly progress after first-line therapy and become unable or ineligible for additional therapies. In the past, treatment beyond four to six cycles of cytotoxic therapy was not recommended owing to lack of benefit and increased toxicity. The purpose of maintenance therapy is to provide an acceptably well-tolerated therapy, allowing patients to maintain a high quality of life with an improved survival. Maintenance therapy with cytotoxic agents such as gemcitabine or docetaxel has provided an advantage in progression-free survival but at the expense of increased cumulative toxicity. However, newer cytotoxic agents, such as pemetrexed, and biologics, such as erlotinib, bevacizumab and cetuximab, have resulted in improved patient overall survival and have offered patients manageable toxicity profiles.