For many years, chemotherapy for advanced or metastatic NSCLC had been limited to the use of “doublet” (two-drug) therapy using different combination regimens that were overall found to have very similar outcomes, but with different toxicity (side effect) profiles. Attempts to add a third chemotherapy agent for a triplet regimen, and numerous attempts to add different targeted-therapy agents, had dismal success. Not only did most of the combinations fail to improve on the survival outcomes, they increased the number of side effects compared with doublet chemotherapy alone.

Over the past several months the topic of so-called maintenance therapy in advanced NSCLC has been one of the most timely and controversy questions in lung cancer. We've had posts here covering a trial testing immediate vs.

At ASCO a little over a month ago we learned the preliminary results of the SATURN trial that compared "maintenance" Tarceva (erlotinib), the oral EGFR inhibitor, to an oral placebo in patients who showed no progression after four cycles of first line chemotherapy.

Maintenance therapy for advanced non-small cell lung cancer was certainly the big theme this year in the lung cancer presentations. Let's start with the Alimta data. Dr. West has outlined earlier results of this study after this data was presented at the 2008 ASCO meeting.

Over the past couple of years a few large trials have emerged that have shown some value in switching patients to a new chemotherapy after, for instance, four cycles of first line chemo for advanced NSCLC, vs. an otherwise very reasonable alternative of stopping treatment in non-progressing patients and following them off of treatment, until progression.

With special thanks to Harvey and Bernice Janssen for providing support to make it possible, I'm pleased to post a new video presentation on the topic of Timing the Transition to Maintenance/Second Line Chemotherapy for Advanced NSCLC. We can expect new information to emerge in the coming months and years, but here is the current snapshot of what we know, along with a little describing what I think (noted as such), about this important topic today.

[powerpress]

For those accessing the audio only version (mp3), the accompanying figures are here, as well as a transcript: