Dr. Sarah Goldberg notes that while maintenance therapy after first line treatment of advanced NSCLC is always worthy of a discussion, many patients need and benefit from a break from treatment to recover before pursuing additional therapy.

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The historic standard for advanced NSCLC up until a few years ago was for patients to complete 4-6 cycles of platinum-based doublet chemo, and then for patients who were doing well and had responded or demonstrated stable disease to take a break from treatment and be followed until progression. At that point, many patients would re-initiate chemo or targeted therapy with an oral agent like Tarceva (erlotinib).

Several weeks ago, my colleagues Dr. Tom Hensing from North Shore Health System in Chicago, affiliated with the University of Chicago, and Dr. David Jackman from Dana Farber Cancer Institute in Boston, were kind enough to take the time to go over a series of cases in a webinar format. We reviewed the time line of several patients with advanced NSCLC, focusing on two central questions:

1) For various clinical situations, which molecular markers would you be inclined to recommend?

A lot of new data have emerged over the last 2-3 years that have addressed the concept of "maintenance therapy" for patients with advanced NSCLC (see Dr. Socinski's excellent podcast for a general review).

We learned several months ago that the ATLAS trial of maintenance Avastin (bevacizumab) with either Tarceva (erlotinib) or placebo did not demonstrate a significant improvement in overall survival (OS) with Tarceva, despite the fact that it was associated with an improvement in progres

I'm very pleased to offer the podcast materials for the recent webinar by Dr. Mark Socinski, medical oncologist and leader of the excellent Thoracic Oncology Program at the University of North Carolina, in Chapel Hill. He's been a long-time leader of the entire field of lung cancer for many years, and he's among the best at synthesizing new information into a cogent perspective.

Here is the audio and video versions of the podcast, along with the figures and transcript that go with the program.

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This is a continuation of the round table format, discussing real life case management with my colleagues who are lung cancer experts at other institutions, This case is the second half of discussion centered around a never-smoking Asian woman who doesn't have an EGFR mutation, and specifically the decision-making process of what first line chemotherapy-based treatment to recommend and whether to continue with maintenance therapy. My guests for the discussion are Drs.

This past weekend, I had the unenviable task of debating my friend Dr. Nasser Hanna, from Indiana University and a highly respected leader in lung cancer, about maintenance therapy.

Patients often ask me, "Why are we only doing four cycles of chemotherapy for my lung cancer?" This is a great question and one for which the answer is a moving target, based on recent data incorporating maintenance therapies. A recently published meta-analysis took another look at this question in NSCLC.

The question of whether we should routinely have advanced NSCLC patients with a response or stable disease after four cycles of first line chemotherapy transition to immediate maintenance therapy or be watched during a treatment break has been the subject of several clinical trials and debates in the lung cancer community over the past couple of years.