SURVIVAL BENEFIT WITH SWITCH MAINTENANCE IN NSCLC

NEW YORK (Reuters Health) May 08 - After a standard course of combination chemotherapy for advanced non-small-cell lung cancer (NSCLC), maintenance therapy with a single agent improves overall survival and progression-free survival, results of a meta-analysis show.

However, "statistical significance was only noted with 'switch' maintenance," i.e., with an agent not in the initial combination regimen, the authors reported in Lung Cancer online April 28.

Dr. Suresh S. Ramalingam, at Emory University in Atlanta, Georgia, and colleagues explain that maintenance therapy is a new treatment paradigm for advanced NSCLC. Prolonged combination chemotherapy beyond four to six cycles is not beneficial, so single-agent maintenance therapy has been studied.

The current meta-analysis included 12 randomized studies (5 meeting abstracts, 7 full manuscripts) comparing 2,449 patients in treatment groups to 1,837 patients in control groups.

Pooled outcome data showed that overall survival was better with maintenance therapy (hazard ratio 0.86; p=0.0003). But 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 did not produce a significant benefit (HR 0.92; p=0.33).

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, quality of life becomes a prime consideration. However, only two trials included such information.

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."