What are the recommendations for continuation maintenance chemotherapy for non-small cell lung cancer (NSCLC) stage IV or recurrent disease?

Updated: Mar 08, 2021
  • Author: Marvaretta M Stevenson, MD; Chief Editor: Nagla Abdel Karim, MD, PhD  more...
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Answer

Answer

Continuation maintenance therapy involves giving chemotherapy that was part of the first-line therapy, after completion of four to six cycles of first-line therapy. This chemotherapy is given until disease progression or unacceptable toxicities occur. The following regimens have been associated with improvements in progression-free survival and overall survival:

  • Cisplatin 80 mg/m2 IV on day 1 plus  vinorelbine 25 mg/m2 IV on days 1 and 8 plus  cetuximab 400 mg/m2 IV loading dose, followed by 250 mg/m2 IV weekly every 21 d; continue cetuximab weekly after four to six cycles completed, until disease progression [45, 46] (for tumors with EGFR-positive immunohistochemistry)

  • Carboplatin AUC 6 IV on day 1 plus paclitaxel 200 mg/m2 IV on day 1 plus  bevacizumab 15 mg/kg IV on day 1 every 21 d; continue bevacizumab every 21 d after four to six cycles completed, until disease progression for patients who meet eligibility requirements (non-squamous histology, treated brain metastases, no history of hemoptysis) [42]

  • Carboplatin AUC 6 IV on day 1 plus  pemetrexed 500 mg/m2 IV on day 1 plus  bevacizumab 15 mg/kg IV on day 1 every 21 d; after four cycles have been completed, pemetrexed and bevacizumab are continued until disease progression (include folate and vitamin B12 supplements along with dexamethasone premedication for pemetrexed) [43]

  • Cisplatin 75 mg/m2 IV on day 1 plus pemetrexed 500 mg/m2 IV on day 1 every 21 d; after four cycles have been completed, pemetrexed is continued until disease progression (include folate and vitamin B12 supplements along with dexamethasone premedication for pemetrexed) [110]


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