What is the value of maintenance therapy in advanced NSCLC, and who should get it?

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We've covered the question of maintenance therapy for lung cancer in many posts over the past 5-6 years as it has evolved from a concept with little evidence to a standard of care, but it is difficult to get a good summary of the big picture. This presentation is my attempt to distill the field into the most important principles.

 

TITAN Trial: Comparison of Chemo and Tarceva in Patients Who Progressed Early on First Line Chemo for Advanced NSCLC

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One of the trials presented at the Chicago Multidisciplinary Symposium in Thoracic Oncology last month was the TITAN trial, one of a pair of studies conducted in Europe to test the oral EGFR inhibitor Tarceva (erlotinib) in patients with chemotherapy pre-treated advanced NSCLC. The other trial, SATURN, was designed to test Tarceva as a maintenance therapy vs.

Lung Cancer FAQ: My advanced NSCLC has progressed after initial chemo. What are the leading options now?

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In the last decade, the treatment of NSCLC has evolved very significantly, and one of the leading ways has been that we've gone from having no established role for treatment after initial, first line therapy to having multiple agents with a proven benefit.

Tarceva for Advanced Squamous NSCLC: Recalibrating Expectations

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When most oncologists think about the EGFR inhibitor tarceva (erlotinib), they think of the uncommon but very memorable patient who has a spectacular response within a few weeks of starting it, then continues to do well on it for a year or more. These patients are most commonly never-smokers, often Asian, and almost invariably have an adenocarcinoma. In contrast, many oncologists perceive there to be little to no value in giving tarceva to patients with squamous tumors, and many don’t even bother to offer it to these patients.