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Following induction therapy, patients with NSCLC may receive maintenance therapy. For patients with nonsquamous histology, following induction therapy with carboplatin and pemetrexed, Jyoti D. Patel, MD, considers maintenance therapy with pemetrexed.
There are 2 strategies for delivering maintenance therapy, notes Benjamin P. Levy, MD: continuation maintenance and switch maintenance. With the continuation strategy, after completing induction therapy, patients discontinue the platinating agent and continue to receive the same non-platinating agent that was used in the induction regimen. With the switch strategy, after induction therapy, patients receive a different agent during maintenance therapy. To date, the only cytotoxic drug approved for maintenance therapy is pemetrexed, comments Levy.
Maintenance chemotherapy may be given immediately after 4 cycles of induction therapy or after a break from treatment. Levy remarks that in his practice, he generally gives maintenance chemotherapy immediately after induction therapy. It is important to discuss maintenance chemotherapy at the beginning of treatment so that patients are aware that they may continue receiving chemotherapy even if their scans show stable disease, adds Levy.