A preponderance of evidence supports the utilization of some form of maintenance therapy for patients with metastatic non-small cell lung cancer (NSCLC). Benjamin P. Levy, MD, suggests that he utilizes an approach similar to the PARAMOUNT study, which administered maintenance pemetrexed following four cycles of pemetrexed plus cisplatin and showed an improvement in both progression-free survival (PFS) and overall survival (OS) compared with placebo. Similarly, Levy notes, the JMEN trial also supported maintenance pemetrexed, with similar findings to PARAMOUNT.

In a clinical trial led by Panos M. Fidias, MD, immediate second-line treatment with docetaxel was compared with a delayed approach for patients with NSCLC who received frontline gemcitabine plus carboplatin. In this study, delaying second-line treatment did not significantly impact OS, although PFS was improved. These findings suggest that treatment can be delayed for some patients without impacting long-term outcomes, notes Mark A. Socinski, MD.

If the first-line treatment is effective, well tolerated, and does not impact the patient’s quality of life, treatment should undoubtedly be continued, Mark G. Kris, MD, believes. Continued conversations with the patient should help indicate the optimal duration of treatment. In general, pemetrexed can be continued for a longer duration without toxicity concerns, notes Socinski. However, this is not generally the case with taxanes.