Determining When to Administer Maintenance Therapy in NSCLC

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Multiple clinical trials have demonstrated improved outcomes with switch and continuation maintenance therapy strategies for patients with non-small cell lung cancer (NSCLC). In many situations, this treatment approach has become the standard of care, notes Corey J. Langer, MD.

The duration of treatment with these therapies is largely based on the patient’s quality of life and side effects. In general, the median age for a majority of patients with NSCLC is 71 years, notes Mark A. Socinski, MD. As a result, these patients usually have comorbidities that prevent them from continuing therapy beyond the initial 4 cycles.

Following initial treatment, Socinksi recommends a reevaluation of the patient and a discussion of the next steps. If toxicity is not a concern and the patient wants to continue, then maintenance is a reasonable choice. However, sometimes the right answer is to take a break, Socinski suggests.

The maintenance therapy conversation should begin prior to the beginning of therapy for newly diagnosed patients with NSCLC, notes Benjamin P. Levy, MD. This provides adequate time for the patient to consider this approach and whether or not they want to pursue it. In general, the decision to administer maintenance therapy should be tailored on an individualized basis, Levy states.

Each maintenance strategies present with unique and sometimes rare side effects, notes Mark G. Kris, MD. The occurrence of edema may call for the discontinuation of treatment, particularly when utilizing the combination of pemetrexed and bevacizumab. Additionally, epiphora or hyperlacrimation and fatigue occur with maintenance therapies, such as pemetrexed, Kris notes. In some situations, renal toxicity may also occur, specifically around the cycles 3 and 4 of treatments, notes Heather A. Wakelee, MD.