For patients with advanced, stable, stage 3B/4 non-small cell lung cancer (NSCLC) who have not progressed after 4 to 6 cycles of platinum-based chemotherapy, the survival benefits were strongest for pemetrexed maintenance therapy followed by maintenance therapy with epidermal growth factor receptor (EGFR) kinase inhibitors, a study published in the Journal of Thoracic Oncology has shown.1

Maintenance therapy may prolong the time to disease progression and may improve overall survival in patients with advanced NSCLC. It may also increase the proportion of patients eligible to receive second-line therapy at the time of progression.

For the study, researchers sought to examine the use of systemic treatment in the maintenance of patients with NSCLC by analyzed data from 14 randomized controlled trials.             

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Studies were included if they compared maintenance systemic therapy with another systemic treatment or placebo in patients with stage 3B or 4 NSCLC. Patients had received a minimum of 4 prior cycles of platinum-based chemotherapy.

Results showed that the overall survival benefit was strongest for maintenance therapy with pemetrexed among patients with non-squamous NSCLC (HR, 0.74; 95% CI: 0.64-0.86); however, the survival benefit with pemetrexed maintenance was not strongest for patients with squamous histology.

Researchers also observed an overall survival benefit with maintenance therapy with EGFR kinase inhibitors, but this effect was smaller than with pemetrexed (HR, 0.84; 95% CI: 0.75-0.94).

Further, the study demonstrated no impact on overall survival with docetaxel or gemcitabine as maintenance chemotherapy.


1. Kulkarni S, Vella ET, Coakley N, et al. The use of systemic treatment in the maintenance of patients with non-small cell lung cancer: a systematic review [published online ahead of print March 21, 2016]. J Thorac Oncol. doi:10.1016/j.jtho.2016.03.007.