[Maintenance therapy in advanced non-small cell lung cancer: A new paradigm?]

Standard treatment of advanced non-small cell lung cancer is based on several lines of therapy separated by treatment-free intervals in which each new line is started when tumour progression is detected. The maintenance strategy consists of pursuing an appropriate, well-tolerated treatment after the end of first-line chemotherapy in order to maintain the initial therapeutic benefit and to avoid rapid clinical deterioration that would rule out further treatment. Two kinds of maintenance therapy have been investigated: continuation maintenance which consists in continuing a targeted agent or a chemotherapy agent that was part of initial induction therapy and switch maintenance defined by initiating a new agent immediately after the end of induction chemotherapy. Clinical trials show that maintenance strategy provides a significant benefit in terms of disease control and improves overall survival for switch maintenance with pemetrexed or erlotinib. Survival benefit appears to be due mainly to the progression-free survival gain and to the increase in the proportion of patients who can receive several lines of treatment. Maintenance therapy is an important option for patients receiving first-line treatment, particularly for those with rapid disease progression. The choice of continuation or switch maintenance will depend on drug used in combination to platinum for induction treatment, response to first-line, histology and patient's preference.