Maintenance Therapy in Lung Cancer: Who, What, Why, When, How

When a patient's disease has been stabilized and controlled through induction therapy, doctors may order maintenance therapy as the next step. This is an encouraging development because it indicates that their cancer has responded positively to the treatment. During this phase, patients can shift their focus to maintaining their stable status. However, it's important to remember that this stage is just as crucial as the ones before it. Individuals should approach it with the same resilience and strength they have already demonstrated. This article will explore what maintenance therapy is and what it means for patients.

Maintenance therapy is the continuation of treatment after a defined number (or cycles) of induction therapy. The induction therapy can be chemo-, immuno-, targeted therapies, or a combination of these therapies.

Maintenance therapy aims to prolong the disease-free period and improve overall survival. The rationale is to:

• Increase exposure to effective therapies
• Circumvent chemotherapy resistance
• Optimize the efficacy of chemotherapeutic agents or antiangiogenic effects
• Alter antitumor immunity, in the case of immunotherapy

As long as drug toxicity is well-tolerated, the treatment is maintained until the disease cancer progresses.

Deciding whether to move forward with this type of treatment involves considering various factors, including the patient's overall health, the stage and type of lung cancer, the response to initial treatment, and the potential side effects of continued treatment.

However, it is crucial that patients can tolerate the drugs used during maintenance therapy. If any signs of toxicity (in the case of late effects) or disease progression appear, the cancer care team will stop the maintenance therapy and start planning for second-line treatment. But even if this happens, there is no need to lose hope, as second-line treatment can still be effective. Place trust in the cancer care team's expertise and their ability to provide the best possible plan for a favorable outcome.

Administered after first-line treatment or the induction therapy. Maintenance may also be recommended in other settings – your doctors will discuss this with you if applicable to your cancer.

There are different ways to maintain lung cancer treatment:

• Continuation maintenance – to maintain using one (single-agent) or two compounds from the induction therapy. If a patient responds well during the first-line treatment, they may continue with the same drugs at a reduced dose or frequency. Drugs from the induction therapy that cause more adverse effects are dropped, while drugs that are well-tolerated are continued.
• Switch maintenance – a drug with a different mode of action (from the drugs in induction therapy) is used in the maintenance therapy. This strategy is usually used to minimize toxicities from the induction therapy. Alternatively, doctors may add another agent (like a targeted drug) to the regimen if they find new cancer-driving pathways.
• Immunotherapy maintenance – Immune checkpoint inhibitors (ICI), a type of immunotherapeutic agent, may be used in combination with chemo drugs in the induction therapy. Patients who responded well to the induction therapy (with low toxicity) and have stable disease (no progression) may continue ICI as maintenance therapy.

It is important for patients to discuss the benefits and risks of maintenance therapy with their oncologist to make an informed decision tailored to their specific situation.

Continue reading: Drugs Used in Lung Cancer Maintenance Therapy