ESMO E-Learning: Maintenance Therapy in Advanced NSCLC

Learning Objectives

  • To learn how to evaluate the benefits and risks of maintenance therapy in patients with advanced non– small cell lung cancer (NSCLC)
  • To summarise currently available data on the use of maintenance therapy in the care of patients with advanced NSCLC
  • To critically analyse how data from new clinical trials on maintenance treatment strategies for advanced NSCLC might affect current treatment practices
Title Duration Content CME Points CME Test
Maintenance Therapy in Advanced NSCLC 50 min. 55 slides 1 Take Test
Silvia Novello
Silvia Novello
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It is well known that identifying molecular and histologic characteristics of non-small cell lung cancer (NSCLC) tumours has a significant impact on the choice of therapeutic agent(s) for specific patient populations and knowing about these factors really formulate strategies for evidence-based care. In this module the focus is on the emerging amount of data on maintenance therapy for patients with advanced stage NSCLC. Despite being an accepted option, practicing physicians still have a lot of lingering questions about who should get maintenance therapy. The decision to treat a patient with maintenance therapy is one that truly reflects the art of medicine. Even more than in other settings, the selection of the right patient population is essential in maintenance therapy. Beyond knowing tumour characteristics, in this case it also involves response assessment to platinum-doublet chemotherapy, remaining toxicity after first line chemotherapy, critical evaluation of patient performance status (PS) and shared decision making between a physician and a patient about what the goals of therapy are, what quality of life is like, and what kind of survival outcomes to expect. In addition, the development of optimal side effect management strategies for patients receiving maintenance therapy for NSCLC, in order to provide optimal care while considering the associated costs, is an important area that medical professionals should be aware of.

This E-Learning module summarises therapies that have been studied in this setting in randomised trials to date. The evolution of this treatment approach is briefly outlined and characteristics that an ideal maintenance agent should possess are examined. It gives an unprecedented level of clinical advice about what to consider in a maintenance treatment approach. Options for maintenance therapy in NSCLC include concepts of continuation maintenance (continuation of non-platinum agent used in doublet chemotherapy), targeted maintenance (triplet induction therapy followed by maintenance with the same targeted agent used in the induction regimen), and switch maintenance (an introduction of a new cytotoxic agent). Therefore, there is no more evidence to support a concept of prolonged administration of doublet first line chemotherapy beyond 4-6 cycles.

Physicians should bear in mind that the maintenance approach is only another treatment possibility that they may consider in those patients who tolerated platinum based therapy, with PS 0 or 1, without relevant clinical toxicities and who desire to continue therapy. The module emphasises that it’s unlikely that all patients will benefit from this approach and advise professionals to check also low grade toxicities, because they also impact on patients’ quality of life in a disease in which the primary goal is palliative and overall survival remains modest.

Last update: 19 April 2013

The author has reported no conflicts of interest.