Open Access Highly Accessed Review

Maintenance therapy in NSCLC: why? To whom? Which agent?

Silvia Novello1*, Michele Milella2, Marcello Tiseo3, Giuseppe Banna4, Diego Cortinovis5, Massimo Di Maio6, Marina Garassino7, Paolo Maione8, Olga Martelli9, Tiziana Vavalà1 and Emilio Bria2

Author Affiliations

1 Thoracic Oncology Unit, University of Turin, AOU, San Luigi Orbassano, Italy

2 Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy

3 Department of Medical Oncology, AOU Parma, Italy

4 Department of Medical Oncology, Cannizzaro Hospital Catania, Italy

5 Department of Medical Oncology, San Gerardo Hospital Monza, Italy

6 Clinical Trials Unit, National Cancer Institute Naples, Italy

7 Department of Medical Oncology, Fatebenefratelli and Oftalmico Hospital, Milan, Italy

8 Department of Medical Oncology, San Giuseppe Moscati Hospital Avellino, Italy

9 Department of Medical Oncology, San Giovanni-Addolorata Hospital Rome, Italy

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Journal of Experimental & Clinical Cancer Research 2011, 30:50  doi:10.1186/1756-9966-30-50

Published: 6 May 2011

Abstract

Maintenance therapy is emerging as a treatment strategy in the management of advanced non small cell lung cancer (NSCLC). Initial trials addressing the question of duration of combination chemotherapy failed to show any overall survival benefit for the prolonged administration over a fixed number of cycles with an increased risk for cumulative toxicity. Nowadays several agents with different ways of administration and a different pattern of toxicity have been formally investigated in the maintenance setting. Maintenance strategies include continuing with an agent already present in the induction regimen or switching to a different one. Taking into consideration that no comparative trials of maintenance with different chemotherapy drugs or targeted agents have been conducted, the choice and the duration of maintenance agents is largely empirical. Furthermore, it is still unknown and it remains an open question if this approach needs to be proposed to every patient in the case of partial/complete response or stable disease after the induction therapy. Here, we critically review available data on maintenance treatment, discussing the possibility to tailor the right treatment to the right patient, in an attempt to optimize costs and benefits of an ever-growing panel of different treatment options.