Maintenance Therapy With Continuous or Switch Strategy in Advanced Non-small Cell Lung Cancer
Abstract
Background Maintenance therapy for patients with non-small cell lung cancer (NSCLC) has gained extensive interest. Varying results for this treatment underpin the need for a synthesis of evidence.Methods Trials investigating maintenance therapy with either a continuous or a switch strategy for patients with nonprogressing NSCLC compared with placebo or observation were identified. The primary outcome was overall survival (OS), and secondary outcomes included progression-free survival (PFS) and toxicity.Results Eight trials of 3,736 patients were included in the analysis. Switch maintenance therapy substantially improved OS compared with placebo or observation (hazard ratio [HR], 0.85; 95% CI, 0.79-0.92; P < .001). A similar trend of improved OS was found in continuous maintenance therapy, despite lacking statistical significance (HR, 0.88; 95% CI, 0.74-1.04; P = .124). The interaction test suggested that the difference in OS between the two maintenance strategies was not statistically significant (P = .777). Clinically substantial and statistically significant improvement in PFS was found with both maintenance strategies (switch maintenance therapy HR, 0.67; 95% CI, 0.57-0.78; continuous maintenance therapy HR, 0.53; 95% CI, 0.43-0.65; interaction P = .128). Subgroup analyses revealed no statistically significant differences in OS or PFS between switch maintenance therapy with cytotoxic agents and that with tyrosine kinase inhibitor agents. Toxicity was greater in maintenance therapy.Conclusions Maintenance therapy with either a continuous or a switch strategy significantly increases OS and PFS compared with placebo or observation. However, the benefits must be balanced against toxicity.
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Randomised trials of continuation maintenance have shown improvements in PFS and OS.
“Randomised trials investigating continuation maintenance have shown an improvement of PFS and OS [79,80].”
From Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up (2016) · cites this paper as [79]
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- Authors
- Zhang, X., Zang, J., Xu, J., Bai, C., Qin, Y., Liu, K., Wu, C., Wu, M., He, Q., Zhang, S., Wei, L., & He, J.
- Affiliations
- Second Military Medical University (CN)
- Corresponding author
- He, Jia
- ORCID
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 2011-07
- Volume
- 140
- Issue
- 1
- Pages
- 117-126
- ISSN
- 0012-3692 (ISSN-L)
- OpenAlex
- W2099904227
- Cited by
- 71
- References
- 33
- Citations by year
- 2025: 2 · 2022: 2 · 2021: 1 · 2019: 3 · 2018: 4 · 2017: 1 · 2016: 8 · 2015: 10 · 2014: 3 · 2013: 18 · 2012: 15
- FWCI
- 2.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- CHEST Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Oncology › Lung Cancer Research Studies
- Keywords
- maintenance therapy, non-small cell lung cancer, overall survival, progression-free survival, tyrosine kinase inhibitors, cytotoxic drugs, treatment toxicity
- MeSH terms
- Carcinoma, Non-Small-Cell Lung, China, Humans, Lung Neoplasms, Survival Rate, Treatment Outcome, Practice Guidelines as Topic, Disease-Free Survival, Protein Kinase Inhibitors
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