Has anyone recently gone through a treatment free interval after induction therapy and before maintenance? Does one of the faculty wish to weigh in? My wife is stage IV NSCLC with poorly differentiated spindle cell histology and stable at last scan. We are weighing options after induction chemo and a rough bout with taxol and hesitate to go to into another cytotoxic drug. We know avastin is a non cytotoxic possibility for immediate maintenance but am curious if anyone with stable stage IV NSCLC has recently decided to go treatment free for a period before starting maintenance. On reviewing the forums it appears not to be a recommended course of action in recent years. Thank you.
P.S. We are trying to get into an anti PD1 trial but are looking at contingencies.
Tom
Reply # - September 25, 2013, 08:57 PM
Reply To: Treatment free interval after induction chemo and
No actually, I and many other lung cancer experts feel extremely comfortable offering some patients a treatment break. Maintenance therapy has become more of a standard of care over the past few years, but that is absolutely driven in no small part by marketing efforts. Maintenance therapy trials have essential just confirmed that people who haven't progressed after 4-6 cycles of initial chemo benefit from additional treatment with the agents that have already been shown to be effective as second line therapy. The actual studies that were used to push the concept of maintenance therapy essentially ensured that all of the people on the maintenance therapy arms of these studies actually got the effective therapy, while only a small minority of people on the control arms got the same treatment...ever.
So these studies don't show that it's important to get the treatment as maintenance therapy. They show that it's important to get additional effective therapy, and maintenance therapy is just a way to ensure that people actually receive the additional treatment after first line. However, I and many other experts feel it's very reasonable to hold treatment for patients who want or need a break, especially if they don't have rapidly progressing disease. And usually after a few months of treatment we have a fair sense of the pace of the underlying cancer.
Good luck.
-Dr. West
Reply # - September 25, 2013, 09:45 PM
Reply To: Treatment free interval after induction chemo and
" ...these studies don’t show that it’s important to get the treatment as maintenance therapy. They show that it’s important to get additional effective therapy..."
It's so difficult for us laypeople to understand the nuances of treatment options such as the possibility that a break (watching closely for progression then start 2nd line) may be better than moving to maintenance (no break). I really like the following post and think it's worth a read or 2 or 3 when coming to the end of first line treatment. http://cancergrace.org/cancer-101/2012/03/17/the-principle-of-letting-t…
I hope your wife is able to rest up for future treatments and that she gets into a pd 1 or L1 trial.
All best,
Janine