Controversies in the management of advanced non-small cell lung cancer: maintenance therapy

The majority of patients with non-small cell lung (NSCLC) present with advanced, metastatic disease at the time of diagnosis. The current state of the art for the management of this condition is first- and second-line chemotherapy (CT), along with appropriate supporting care measures, which are supposed to alleviate symptoms and to improve survival. During the last years, maintenance therapy (MT) was included in the therapeutic algorithm for these patients. MT could be defined as continuation of an active treatment until disease progression in patients who demonstrated a non-progressing status following induction chemotherapy. Despite the results of several randomized trials showing a significant benefit by using this approach, the strategy is far from being universally accepted. The internationally recognized guidelines provide different recommendation when it comes to this topic, while some major drawbacks in the design of the positive clinical trials may have distorted the relevance of the communicated data. This paper aimed to review the most contentious aspects which should be considered while contemplating the use of MT in the daily clinical practice.