Maintenance therapy for metastatic non-small-cell lung cancer - the role of pemetrexed

Over the last several years, we have greatly enhanced our understanding of tumor biology and have now integrated novel and molecular-targeted therapies into front-line treatment for locally advanced and metastatic non-small-cell lung cancer (NSCLC). Despite all the recent advances, the improvement in survival outcomes for these patients has been measured in weeks compared to historical controls. Clinical researchers continue to search for the silver bullet that will allow oncologists to treat lung cancer as a chronic illness and prolong life well beyond the statistical barrier of 1 year for these patients. In that vein, maintenance therapy is emerging as a new treatment option in the metastatic setting. However, there is much controversy over the validity and cost-effectiveness of this modality. Recently, a phase III trial of pemetrexed maintenance versus best supportive care in the setting of metastatic NSCLC following non-progression after 4 cycles of platinum-based doublet therapy showed significant survival outcomes of the treatment group. This article will review the current available treatment options in metastatic NSCLC, including maintenance regimens, with particular attention paid to the recent pemetrexed study.