Maintenance Therapy for Patients with Lung Cancer

Heather Wakelee, MD, an assistant professor at the Stanford University School of Medicine and member of the Stanford Cancer Institute, discusses maintenance therapy for patients with lung cancer.

When it comes to maintenance therapy, Wakelee says, there is continuation maintenance and there is switch maintenance. Wakelee says she prefers continuation maintenance therapy because there is strong data for that approach, especially with pemetrexed. There is also data to back up switch maintenance, especially when using erlotinib or pemetrexed.

For the first time, the ECOG-5508 trial will look at bevacizumab and pemetrexed both alone and in combination as continued maintenance, Wakelee says, but the results of the trial are not yet available.

Wakelee feels if a patient is started on a first-line regimen that contains a platinum doublet with pemetrexed, there is data that strongly suggests continuing pemetrexed.

The results of some maintenance therapy trials have left physicians confused about which therapies to use, but Wakelee believes that there are now a lot of options and it is up to physicians and patients to determine which therapy is best in a given situation.

Clinical Pearls

• There are benefits to both continue maintenance and switch maintenance
• A clinical trial will compare bevacizumab and pemetrexed both alone and in combination as continued maintenance
• Maintenance therapy should be discussed between the patient and the physician