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Lung Cancer

Sequential, Alternating, and Maintenance/Consolidation Chemotherapy in Advanced Non-Small Cell Lung Cancer: A Review of the Literature

^aMedical Oncology A, Disease Management Team – Lung Cancer, National Institute for Cancer Research, Genoa, Italy; ^bDepartment of Medical Oncology, University Hospital of Udine, Udine, Italy

Key Words. Chemotherapy design strategies • Advanced non-small cell lung cancer • Sequential chemotherapy • Alternating chemotherapy • Maintenance/consolidation chemotherapy

Correspondence: Correspondence: Francesco Grossi, M.D., Medical Oncology A, National Institute for Cancer Research, Largo Rosanna Benzi 10, 16132 Genoa, Italy. Telephone: 39-010-560-0665; Fax: 39-010-560-0850; e-mail: francesco.grossi{at}istge

A platinum-based doublet with a third-generation agent (paclitaxel, vinorelbine, gemcitabine, docetaxel) represents the standard first-line treatment for advanced non-small cell lung cancer patients with good performance status (PS). Traditional chemotherapy provides response rates of 20%–40% and a median survival of 8–10 months. In an attempt to improve its outcome, alternative schedules have been proposed, namely sequential, alternating, and maintenance/consolidation therapy.

Sequential chemotherapy with a platinum-based doublet followed by a single agent is feasible in patients with good PS; preliminary results from randomized phase III trials with combination chemotherapy as a comparator are promising, suggesting similar efficacy and a better toxicity profile for the sequential arm. The use of sequential single agents is an option for elderly and frail patients unsuitable for a platinum-based combination.

Based on trials published so far, it is unlikely that an alternating chemotherapy strategy will be proven superior to standard chemotherapy in patients with good PS. However, sufficient evidence exists that it could be appropriate in the elderly or in unfit individuals

Consolidation/maintenance chemotherapy may provide additional benefit for patients achieving disease control after standard first-line chemotherapy. Better results are seen when maintenance consists of an agent that has proven active in the induction phase. Further evaluation of this strategy, as well as of consolidation/maintenance therapy with targeted agents, is warranted.

In conclusion, these approaches may improve the outcome in selected patients with advanced non-small cell lung cancer, but further results from randomized trials are needed. In the meantime, sequential, alternating, and maintenance/consolidation therapy should still be considered investigational.

Disclosure of potential conflicts of interest is found at the end of this article.