Maintaining clarity: Review of maintenance therapy in non-small cell lung cancer

Table 1 A list with pertinent details of large randomized maintenance therapy trials in non-small cell lung cancer

Maintenance		PFS (mo)	HR	P	95%CI	PFS + induction	HR	P	95%CI	OS (mo)	HR	P	95%CI	OS + induction (mo)	HR	P	95%CI	Genotype	Post-TX
Vinorelbine 25 mg/m2 q weekly	× 6 m until PD	5.0				NR				12.3				NR				NC	Etoposide 80 mg/m2, cisplatin 30 mg/m2
vs						NR	NR	NR	NR	12.3	1.08	0.65		NR	NR	NR	NR
Observation		3.0	0.77	0.110	0.56-1.07
Gemcitabine 1250 mg/m2 q21 d	Until PD/ removal request	3.6 (TTP)				6.6 (TTP + induction)				10.2				13.0				NC	Second line chemotherapy/ radiation
vs
BSC		2.0 (TTP)	0.70	0.001	0.50-0.90	5.0 (TTP + induction)	0.70	0.001	0.50-0.90	8.1		0.172		11.0	NR	0.195
Bevacizumab 15 mg/kg q3 wk	Until PD	6.2	0.66	0.001	0.57-0.77	NR	NR	NR	NR	12.3	0.79	0.003	0.67-0.92	NR	NR	NR
vs
Observation		4.5				NR				10.3				NR				NC	None reported
Pemetrexed 500 mg/m2 q21 d	Until PD	4.3				7.7				13.4				16.5				NC	Pemetrexed, docetaxel, erlotinib, gefitinib, vinorelbine, gemcitabine, carboplatin, cisplatin, paclitaxel
vs
Placebo		2.6	0.50	0.0001	0.42-0.61	5.9	0.50	0.0001	0.42-0.61	10.6	0.79	0.012	0.65-0.95	13.9	0.79	0.012	0.65-0.95
Immediate docetaxel 75 mg/m2 q21 d	× 6 cycles	5.7				NR				12.3				NR	NR			NC	Best supportive care, observed for PD/ survival
vs
Delayed docetaxel 75 mg/m2 (start at PD) q21 d		2.7	NR	0.0001	2.60-2.90 m	NR	NR	NR	NR	9.7	NR	0.853		NR	NR	NR	NR
Pemetrexed 500 mg/kg + bevacizumab 15 mg/kg q21 d	Until PD or discontinued	6.0				8.6				12.6				17.7	NR			Collected-no specific results	None reported
vs
Bevacizumab 15 mg/kg q21 d	Until PD or discontinued	5.6	0.83	0.012	0.70-0.96	6.9	NR	NR	NR	13.4	1.00	0.949		15.7	NR	NR	NR
Cetuxamab 250 mg/m2 weekly	Until PD/ toxicities	4.8	0.94	0.390	0.82-1.07	NR	NR	NR	NR	11.3	0.87	0.044	0.76-0.99	NR	NR	NR	NR	Collected- EGFR (IHC)	None reported
Observation		4.8								10.1
Bevacizumab 7.5 mg/m2	Until PD	6.7	0.75	0.003		NR	NR	NR	NR	Not sufficient				NR	NR	NR	NR	NC	No bevacizumab
vs
Bevacizumab 15 mg/m2		6.5	0.82	0.030
vs
Placebo		6.1
Erlotinib 150 mg/d	Until PD/ toxicities/ death	4.1				NR	NR			12.0				NR	NR			EGFR/wild type/ resistance mutations	Erlotinib (people in placebo group that were egfr +, taxanes (+ docetaxel), antimetabolics (+ pemetrexed), platinums, antineoplastics
vs
Placebo		2.75	0.71	0.0001	0.62-0.82	NR	NR	NR	NR	11.0	0.81	0.009	0.70-0.95	NR	NR	NR	NR
Cetuximab 250 mg/m2 weekly	Until PD/ toxicities	4.4	0.90	0.236	0.76-1.06	NR	NR	NR	NR	9.6	0.89	0.169	0.75-1.05	NR	NR	NR	NR	Not included in study	None reported
Observation		4.2								8.3
Pemetrexed 500 mg/m2 q3 wk	Until PD	4.1				6.9				13.9				16.9				NC	Erlotinib, docetaxel, gemcitabine, vinorelbine, cisplatin, bevacizumab, investigational drug
vs
Placebo		2.8	0.62	0.0001	0.49-0.79	5.6	0.59	0.0001	0.47-0.74	11.0	0.78	0.020	0.64-0.96	14.0	0.78	0.019	0.64-0.96
Gemcitabine 1250 mg/m2 q3 wk	Until PD/ toxicity/death	3.0	0.56	0.001	0.44-0.72	NR				12.1	0.89	0.387		15.2	0.72	NS		EGFR mutations/ expressions (exon 19 deletions, mutations in exon 21 and L858R point mutations)	Pemetrexed 500 mg/m2 q21 d, erlotinib, docetaxel
vs
Erlotinib 150 mg/d q3 wk	Until PD/ toxicity/death	2.9	0.69	0.003	0.54-0.88	NR				11.4	0.87	0.304		NR	NR
vs
Observation		1.9				NR				10.0				10.8
Pemetrexed 500 mg/kg + bevacizumab 7.5 mg/kg q3 wk	Until PD	7.4	0.48	0.001	0.35-0.66	10.2	0.50	0.001	0.37-0.69	NR	0.75	0.219	0.47-1.19	NR	0.75	0.230	0.47-1.20	NC	Taxanes/TKI
vs
Bevacizumab 7.5 mg/m2 q3 wk	Until PD	3.7				6.6				12.8				15.0

PFS: Progression-free survival; OS: Overall survival; NS-NSCLC: Nonsquamous non-small cell lung cancer; NR: Not reported; NC: Not collected; PD: Progressive disease; TKI: Tyrosine kinase inhibitors; EGFR: Epidermal growth factor receptor.