Maintenance Chemotherapy for Lung Cancer

The Abramson Cancer Center of the University of Pennsylvania
Last Modified: May 8, 2013

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Question

My sister's doctor told her she would be getting "maintenance chemo." Can you explain what that means? I have tried searching the web, but I cannot find anything about it.

Answer

Tracey Evans, MD, Medical Oncologist at Penn Medicine, responds:

Maintenance therapy is therapy given after the initial cycles of chemotherapy to keep the cancer in check. This is a relatively new concept in advanced non-small cell lung cancer treatment. For quite a while, it had been shown that patients who got more than 4-6 cycles of chemotherapy did not do any better than patients who stopped treatment following 4-6 cycles, and they actually had more side effects from treatment. The standard of care, therefore, used to be to follow patients with scans and only re-start treatment once the cancer started to grow. Now, however, there are some newer medications that are generally better tolerated and that have data showing that it is better to start them immediately after completing the inital rounds of chemotherapy and then stay on the treatment until the cancer gets worse rather than WAITING for the cancer to get worse before starting the treatment. Both pemetrexed (an intravenous chemotherapy) and erlotinib (a pill) have been shown to benefit patients as maintenance therapy and are generally well tolerated. Also, patients who receive bevacizumab as part of their initial chemotherapy treatment often stay on this drug beyond their initial 4-6 cycles of combination chemotherapy, assuming they are tolerating it ok. The concept of maintenance therapy is somewhat controversial as the treatments do carry with them some toxicity, and it is not clear that the benefit of maintenance therapy is worth the toxicity, inconvenience, and expense of continuing treatment indefinitely. However, I would say that given the available data, maintenance therapy is the maximally aggressive approach for patients who can tolerate it.