Maintenance Combination Therapy in NSCLC

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Maintenance therapy may be appropriate for individuals who tolerate induction therapy well and have a good performance status, according to Thomas E. Stinchcombe, MD. In patients with non-squamous non-small cell lung cancer (NSCLC) who have received combination carboplatin/paclitaxel/bevacizumab, Stinchcombe uses bevacizumab maintenance; for patients who received carboplatin/pemetrexed therapy, he administers pemetrexed maintenance. Depending on patient preference, treatment breaks are also a viable option.

The ECOG 5508 study, remarks Heather A. Wakelee, MD, is assessing 2 maintenance strategies for patients who successfully completed treatment with carboplatin/paclitaxel/bevacizumab. In the study, patients will be randomized to receive either bevacizumab alone or bevacizumab plus pemetrexed. The AVAPERL trial demonstrated an improvement in progression-free survival in patients who received both pemetrexed and bevacizumab in the maintenance setting; however, an overall survival advantage remained elusive. Findings from ECOG 5508 will help confirm whether or not the administration of this regimen is warranted.

While most maintenance therapy is administered to the non-squamous population, Anne S. Tsao, MD, comments that she implements maintenance therapy of erlotinib following cisplatin and docetaxel or carboplatin and paclitaxel in patients with squamous cell NSCLC.