Case Study: Maintenance Therapy in Squamous NSCLC

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In the continuation of a case-based discussion, panelists describe the appropriateness of maintenance therapy for a functional 77 year-old man with squamous non-small cell lung cancer (NSCLC). The patient should receive an initial doublet therapy, administered on a weekly schedule, suggests Everett E. Vokes, MD. Following 4 to 6 weeks of treatment, maintenance therapy should be discussed as an option but should not automatically be administered, Vokes believes.

Erlotinib was suggested as a potential maintenance therapy; however, Karen L. Reckamp, MD, MS, notes that she does not utilize it in this setting. If a patient responds well to the initial regimen, such as gemcitabine, without significant toxicity, Reckamp suggests continuing this treatment. However, if the initial regimen includes a taxane, a break from treatment may be required.

While he would not automatically recommend maintenance therapy, Roy S. Herbst, MD, PhD, does discuss it as an option with his patients. If maintenance is required, Herbst recommends erlotinib or gemcitabine. Following the initial treatment, the patient should be observed for signs of continued tumor growth by imaging every 8 weeks to 3 months.

At this point, moderator Corey J. Langer, MD, changes the scenario by noting that the patient has adenocarcinoma rather than squamous cell NSCLC. Outside of this, the clinical presentation is the same. In this situation, Langer wonders if treatment with bevacizumab is appropriate. This patient should still be treated with an initial doublet regimen and not a single agent, Vokes emphasizes. Additionally, he adds, given the patient's age, there is not an advantage for adding bevacizumab to the doublet.