However, “statistical significance was only noted with ‘switch’ maintenance,” i.e., with an agent not in the initial combination regimen, the authors note in their report in Lung Cancer online April 28.
Dr. Suresh S. Ramalingam, at Emory University School of Medicine in Atlanta, Georgia, and colleagues explain that maintenance therapy is a new treatment paradigm for advanced NSCLC. Prolonged combination chemotherapy beyond 4 to 6 cycles is not beneficial, so single-agent maintenance therapy has been studied.
To evaluate the strategy, the team conducted a meta-analysis of 12 randomized studies that compared single-agent maintenance therapy in a total of 2449 NSCLC patients to a control arm of 1837 patients.
Pooled outcome data showed that overall survival was better with maintenance therapy (hazard ratio 0.86; p=0.0003). However on further analysis, the survival advantage was only seen with ‘switch’ maintenance (HR 0.84; p=0.00026); ‘continuation’ maintenance with an agent included in the initial combination chemo regimen was not associated with a significant benefit (HR 0.92; p=0.33), the investigators found.
Similarly, progression-free survival favored the use of ‘switch’ maintenance (HR 0.62; p<0.0001), as ‘continuation’ maintenance produced a relatively modest benefit (HR 0.90; p=0.007), according to the report.
Generally, overall survival and progression-free survival were improved with both cytotoxic agents and EGFR inhibitors, the authors note.
Discussing the clinical implications, they comment that, given the modest benefit achieved with some single agents, patients’ quality of life becomes a prime consideration. However, as only two of the trials included such information, they found the current evidence inconclusive in this regard.
Summing up, Dr. Ramalingam and colleagues conclude, “The present meta-analysis provides clear evidence in support of the use of maintenance therapy as a ‘standard of care’ for patients with advanced NSCLC. The decision to use maintenance therapy should be based on an individualized approach that includes patient-specific factors and tumor-specific biomarkers.”