Can maintenance therapy improve survival?

This phase III clinical trial evaluated the impact continuing pemetrexed (Alimta) therapy in patients with advanced Non-Small-Cell Lung Cancer (NSCLC) after an initial treatment with pemetrexed plus cisplatin (Platinol). 

In patients with advanced NSCLC, when the cancer has begun to spread beyond the lungs, the most common therapy option is chemotherapy to shrink the cancer and prevent its spreading. Most chemotherapy treatments involve combinations of different drugs such as pemetrexed plus cisplatin. Pemetrexed prevents cells from making DNA and RNA, which are required for the growth and survival of both normal cells and cancer cells. On the other hand, cisplatin damages DNA, thus stopping cancer cells from growing and causing them to die.

However, to retain the effect of the initial treatment, maintenance therapy is often given. Maintenance therapy means continuing therapy after the disease is stabilized following initial therapy. Although the concept of maintenance therapy is not new, it is becoming a more common treatment approach for many different types of cancer. This study investigated the efficacy of using pemetrexed as a maintenance therapy for NSCLC.

A total of 539 NSCLC patients whose disease was controlled (no disease progression) after completing four cycles of pemetrexed-cisplatin treatment were involved in this study. 359 patients were randomly assigned to maintenance therapy with pemetrexed on day one of 21-day cycles, while the other 180 were assigned to a placebo (a substance with no medical effect, used as a control when testing new drugs).

After approximately 2 years of follow up, overall survival was significantly longer for patients in the pemetrexed maintenance therapy group (13.9 months) compared to patients in the placebo group (11 months). Progression-free survival (the time patients survived without progression of their disease) was 38% higher in the pemetrexed maintenance therapy group compared to the placebo group. However, patients treated with pemetrexed reported more adverse effects such as low red blood cells (anemia), high risk of infections or tiredness compared to patients treated with placebo.

In summary, this trial found that in patients with controlled NSCLC after initial treatment with pemetrexed plus cisplatin, maintenance therapy with pemetrexed was an effective and well-tolerated treatment option.

This study was partly founded by Eli Lilly, the manufacturer of Alimta.

Ask your doctor what is the most appropriate treatment option in your situation.