Non-small cell lung cancer (NSCLC) remains the most common cause of cancer-related death in the United States. Survival for patients with advanced disease remains meager with standard platinum-based doublet therapy even given initially. Improved efficacy and tolerability of third-generation chemotherapies and small-molecule inhibitors has prompted the evaluation of these agents in the maintenance setting in order to enhance current outcomes. Two separate strategies have evolved: the introduction of a non-cross-resistant drug immediately following first-line or induction chemotherapy (switch maintenance), or the continuation of the non-platinum partner initially introduced during induction (continuation maintenance). Here we review the available clinical trial data evaluating both maintenance strategies, and offer our assessment of their contemporary clinical implications and cost-effectiveness.
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