The role of maintenance chemotherapy in advanced nonsmall cell lung cancer

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Abstract
Advanced nonsmall cell lung cancer (NSCLC) remains a therapeutic challenge. Traditional chemotherapy provides response rates of about 20-40% and median survivals of 8-10 months. The outcome of patients presenting at an advanced stage is therefore disappointing. In order to improve patients' outcomes, there has been a renewed interest in evaluating the role of maintenance or consolidation chemotherapy or both. Therefore, this review is timely and also relevant to clinical practice. Thirteen randomized clinical trials have reported that consolidation or maintenance therapy or both improves progression free survival in patients with advanced NSCLC who have achieved disease control following their initial therapy. This does not translate into survival benefits in the same patient populations. Furthermore, prolonged therapy results in more treatment-related toxicity without improvements in quality of life as documented in 11 of these trials. We summarize the current data and perspectives of consolidation/maintenance therapy in patients with advanced NSCLC. Completed trials evaluating consolidation or maintenance therapy or both in patients with advanced NSCLC consistently demonstrate that this strategy will improve progression free survival but not overall survival. Administering maintenance or consolidation therapy to patients with advanced NSCLC to improve progression free survival alone is not recommended.

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