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Maintenance cytotoxic therapy prolongs survival in patients with advanced stage, nonsquamous NSCLC, notes Benjamin P. Levy, MD. Data from controlled clinical trials suggest that patients with non-squamous NSCLC who achieve stable disease after undergoing 4 cycles of a platinum- or pemetrexed-based regimen should receive maintenance therapy. Pemetrexed is the only cytotoxic chemotherapy that has shown a survival advantage in phase 3 studies, remarks Levy.
Prior to the introduction of pemetrexed, chemotherapy could not be given for an extended time due to the substantial toxicity associated with previous drugs (eg, myelosuppression, neuropathy), comments Jyoti D. Patel, MD. With pemetrexed, clinicians can deliver cytotoxic therapy for a longer duration of time, as its toxicity profile is more modest. Toxicities associated with pemetrexed include fatigue, myelosuppression, and renal toxicity.
After the completion of 4 to 6 cycles of platinum-based chemotherapy, many individuals with stage 4 NSCLC are candidates for additional or subsequent lines of therapy, notes Primo N. Lara, Jr, MD. Additional therapy can be given as either second-line therapy, in which case there is an intervening rest period between first-line therapy and second-line therapy, or maintenance therapy, in which case the initial 4 to 6 cycles of platinum-based therapy are immediately followed by additional cycles of single-agent cytotoxic therapy.