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Lung Cancer

Potential Treatment Options After First-Line Chemotherapy for Advanced NSCLC: Maintenance Treatment or Early Second-Line?

^aDivision of Medical Oncology, S.G. Moscati Hospital, Avellino, Italy; ^bDivision of Medical Oncology, Second University of Naples, Naples, Italy

Key Words. Advanced NSCLC • Maintenance chemotherapy • Early second-line treatment • Targeted therapies

Correspondence: Cesare Gridelli, M.D., Division of Medical Oncology, "S.G. Moscati" Hospital, Contrada Amoretta, 83100 Avellino, Italy. Telephone: 39-0825-203574; Fax: 39-0825-203556; e-mail: cgridelli{at}libero.it

Received July 16, 2008; accepted for publication January 7, 2009; first published online in THE ONCOLOGIST Express on February 3, 2009.

Disclosures

Cesare Gridelli: Consultant/advisory role: Eli Lilly, Roche, Merck-Serono, Sanofi-Aventis; Paolo Maione: None; Antonio Rossi: None; Marianna Luciana Ferrara: None; Maria Anna Bareschino: None; Clorinda Schettino: None; Paola Claudia Sacco: None; Fortunato Ciardiello: Consultant/advisory role: Roche, Merck-Serono.

The article discusses erlotinib (Roche), used for maintenance; gefitinib (Astra Zeneca), used for maintenance; and pemetrexed (Eli Lilly), used for maintenance.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by independent peer reviewers.

Although substantial progress has been made in the therapeutic options currently available for patients with advanced non-small cell lung cancer (NSCLC), the overall survival profile remains poor for most patients. One of the strategies currently under investigation with the aim of prolonging survival in NSCLC patients is maintenance treatment with either a chemotherapeutic agent or a molecularly targeted agent after first-line chemotherapy. Moreover, this can consist of drugs included in the induction regimen or other noncrossresistant agents. With the currently available data, maintenance treatment with a different noncrossresistant agent (i.e., an early second-line treatment) is perhaps the most promising strategy. The drug chosen for the early second-line treatment should be a well-tolerated agent, considering that patients have just completed a particularly toxic platinum-based chemotherapy. Extending treatment with targeted agents rather than chemotherapy can provide longer progression-free and overall survival times without increasing toxicity. However, at the moment, only progression-free survival has been shown to be consistently superior with maintenance approaches; the evaluation of survival benefits is warranted before defining this strategy as a possible treatment option. Further studies are warranted to establish the role of maintenance chemotherapy in patients with advanced NSCLC.