What Is Maintenance Therapy
Mesothelioma maintenance therapy is ongoing treatment with medication after the tumors have responded to the first phase of treatment.
Maintenance therapy aims to prevent recurrence or delay the growth of cancer cells following primary mesothelioma treatment. Some patients may remain on maintenance therapy for long periods depending on their bodys response.
Ongoing research is investigating the value of maintenance therapy for mesothelioma to determine which therapies are most effective. The U.S. Food and Drug Administration has yet to approve any drugs for maintenance therapy, but mesothelioma specialists still recommend maintenance therapy to patients.
What Is Palliative Chemotherapy
Cancer specialists recommend chemotherapy in one of two situations. For some cancers, chemotherapy can completely get rid of the cancer with a good chance that it will never come back. Examples include certain types of lymphoma, leukemia and testicular cancer, among others. For most cancers that have metastasized , chemotherapy cannot cure the cancer. However, chemotherapy may be helpful in shrinking the cancer, improving or completely eliminating distressing symptoms caused by the cancer for a period of time and helping you live longer. The use of chemotherapy in these situations is called palliative chemotherapy.
What information do you need from the oncologist to help you decide if palliative chemotherapy is right for you or your loved one?
Here are some important questions to ask:
How Long Must I Continue Treatment
Standard practice is to wait for one-two full cycles of treatment before looking at the cancers response to it. If your cancer is responding to the treatment, your doctor will likely recommend continuing the chemotherapy until the cancer stops growing or you develop unacceptable side effects from the treatment.
Don’t Miss: Cancer Treatment Side Effects Radiation
How To Prepare For Maintenance Therapy
To prepare for mesothelioma maintenance therapy, establish a support system. A network of family, friends and neighbors can help when you need assistance. You can rely on others for help around the house or traveling to medical appointments. It is also important to let your employers human resources department know about your ongoing treatment for more support and understanding at work.
In addition, those receiving chemotherapy should plan to protect household members from exposure to bodily fluids which may contain toxic chemotherapy drugs.
Goals Of Maintenance Therapy
There are several ways that maintenance therapy can help NSCLC patients:
- Identify a more effective treatment: It’s not always possible to predict which drugs will be most effective against your cancer. A new drug introduced during maintenance therapy may work better than something you’ve tried before.
- Protect against chemotherapy resistance: Sometimes chemotherapy drugs that work well at first stop being effective, and cancer starts growing again. This happens when cancer develops resistance after prolonged exposure. Switching the medications may help avoid this problem.
- Optimize chemotherapy: When a new drug is incorporated, or part of a drug combination is stopped, it can improve effectiveness due to the way the drugs interact with each other.
- Create antiangiogenic effects:Certain drugs can stop tumor blood vessels from forming, which prevents the tumors from growing.
- Improve antitumor immunity: Some maintenance therapies help your own immune system destroy cancer cells.
Read Also: What Genes Are Mutated To Cause Cancer
Types Of Maintenance Therapy
The types of maintenance therapy for mesothelioma include chemotherapy, immunotherapy and targeted therapies. These therapies are available at the nations top mesothelioma cancer centers.
Maintenance chemotherapy, sometimes called continuous therapy or switch-maintenance therapy, has been studied the most in mesothelioma. According to research, Alimta alone is not an effective maintenance therapy drug for mesothelioma. But investigators continue to evaluate Alimta, along with the medication Gemzar, for potential benefits.
A 2021 phase II study published in The Lancet investigated switch-maintenance chemotherapy in pleural mesothelioma patients. After initial treatment with Alimta and cisplatin or carboplatin, half the participants switched to Gemzar and supportive care. The other half received only supportive care. The Gemzar group lived three months longer, and their tumors didnt progress as quickly as the supportive care group. They also enjoyed a better quality of life.
Maintenance immunotherapy and targeted therapy are less understood than maintenance chemotherapy for mesothelioma. However, specialists recommend these treatments to patients who meet certain eligibility criteria. For example, patients who do not respond well to chemotherapy may be considered for immunotherapy and targeted therapy drugs.
Why Is Maintenance Therapy Used
- To prevent or delay the cancers return if the cancer is in remission after initial treatment. Maintenance therapy is generally approved for use where it has been demonstrated in clinical trials to prolong survival for a specific cancer, leukemia, or lymphoma.
- Sometimes maintenance therapy is used to slow the growth of advanced cancer after initial treatment. This can help shrink the cancer, which is called a partial remission. In this situation, maintenance therapy is not used to cure the cancer, but it can lengthen a persons life.
Don’t Miss: How Many Times Can You Do Radiation Therapy
Maintenance Therapy For Lung Cancer
Maintenance therapy is ongoing therapy for a disease that is administered after the acute phase of treatment has been completed. In the case of lung cancer, you would undergo first-line chemotherapy for a limited period of time, and then you might receive maintenance therapy to keep the cancer in check. The goal is to improve quality of life while offering a chance for longer survival.
What To Expect When Getting Maintenance Therapy
Your experience with maintenance therapy for mesothelioma depends on the type of therapy your doctor recommends. How therapy is administered, how long you need to take it and whether maintenance therapy is combined with other treatments varies greatly.
For example, chemotherapy, immunotherapy and certain targeted therapies are provided through an IV infusion given in cycles with breaks in between. Other targeted therapy drugs come in pill form. You can expect your doctor to closely monitor your health with blood tests and imaging scans while on maintenance therapy to ensure it is working. Maintenance therapy cant cure mesothelioma, but it may help keep cancer in remission longer.
Find Ways to Pay for Mesothelioma Treatment
You May Like: Natural Remedies For Cancer In Dogs
Daughter In Maintenance Stage All
Hi All, I am new to the community and after searching forums wondered if anyone has had a simiar experiance – my dd was diagnosed with ALL in May 2015. She is currently well into the maintenance phase and, since dec, her hair had grown back very thick and beautiful… however, as of 3 months ago, it has started to fall again and is now at the point of her needing to once again wear scarves.
My question is, has anyone else experianced this much hair loss during maintenance phase after regrowth? She is finding it very distressing this time around as we were not expecting so much to fall, thin yes, but not complete loss again!…. is this what she can now expect until treatment finishes ? Its so hard to give her an answer as i can’t get my head around why when the treatment has been the same since dec, the hair grew but has now mainly gone again!
Hope that makes sense? Thanks so much for reading, This has been the hardest 18 months of our lives.
i saw that no one else had replied and even though our circumstances are very different to yours, I thought I would add a comment
You referred to maintenance and “ALL”, which are not terms with which I am familiar.
Alrhough the experiences are not exactly the same, what we found was that the second growth was closer to her original hair type. Obviously your experience is different, but I just hope this anecdote might reassure your daughter. .
Managing Cancer As A Chronic Illness
Cancer isnt always a one-time event. Cancer can be closely watched and treated, but sometimes it never completely goes away. It can be a chronic illness, much like diabetes or heart disease. This is often the case with certain cancer types, such as ovarian cancer, chronic leukemias, and some lymphomas. Sometimes cancers that have spread or have come back in other parts of the body, like metastatic breast or prostate cancer, also become chronic cancers.
The cancer may be controlled with treatment, meaning it might seem to go away or stay the same. The cancer may not grow or spread as long as youre getting treatment. Sometimes when treatment shrinks the cancer, you can take a break until the cancer starts to grow again. But in either of these cases the cancer is still there it doesnt go away and stay away its not cured.
Living with cancer is different from living after cancer. And its becoming more common every day.
You May Like: Mouth Sores From Chemo Pictures
How Is Maintenance Therapy Used To Treat Advanced Cancer
For many types of advanced cancer, the initial treatments can shrink the cancer and prevent it from spreading, but the cancer is not gone. For some of these cancer types, maintenance therapy can delay cancer progression and prolong survival. Maintenance therapy is now commonly used after initial treatment for several advanced cancers, such as advanced lung cancer, colorectal cancer, ovarian cancer, and some types of lymphoma.
When recommended, maintenance therapy can:
Continue treatment similar the initial treatment regimen. For many types of cancer, the first treatment is combination chemotherapy. This is a treatment plan that includes more than 1 type of chemotherapy. This kind of treatment regimen can be intensive and it may be difficult to have for long periods of time due to the potential for severe side effects. If the combination chemotherapy treatment is still working to treat the cancer, the regimen can be modified over time. This is considered a “maintenance regimen.”
Side effects from maintenance regimens are often easier to manage than those from the intensive initial treatment. And if needed, there are different ways your doctor can modify the original treatment plan:
Reducing the number of drugs in the combination
Lowering the dose of each drug
Changing how often the patient receive doses
Substituting similar drugs that may cause less side effects
What Is The Role Of Maintenance Therapy In Cancer Care
Experts provide an in-depth look at the treatment strategy in patients with solid tumors, specifically looking at the role of maintenance therapy.
Dennis Citrin, MD, PhD
Ten years ago, Dennis Citrin, MD, PhD watched as patients with metastatic nonsmall cell lung cancer died, despite treatment, 6 to 12 months after diagnosis.
These days, through the use of chemotherapies and targeted treatments the doctor is able to usher many of them into remission.
Its a transformation that has, in turn, created the need for longer-term treatment strategiesnot just for patients with NSCLC, but for those with other solid tumor types in which prognoses have improved, said Citrin, MD, Phd, of the Cancer Treatment Centers of America.
Increasingly, the oncology community is looking to meet that need with maintenance therapy , a strategy that involves immediately following a successful first-line treatment with a component of the same regimen , or with a different therapy that is effective and well-tolerated .
Heather Wakelee, MD
Without some of the newer, less-toxic cancer medications, MT wouldnt be a workable strategy, particularly in NSCLC, noted Heather Wakelee, MD, assistant professor of Medicine in the Division of Oncology at Stanford University, in California.
Debu Tripathy, MD
Corey Langer, MD
In Langers opinion, the toxicity associated with maintenance pemetrexed is minimal, and hes seen it work well in patients.
Recommended Reading: Neck Pain Radiates To Head
What Is Maintenance Therapy In Cancer
Following the primary treatment of cancer doctor may recommend additional treatment with maintenance therapy. The goal of maintenance therapy is not to cure the cancer but to maintain a remission or prevent or delay the cancer’s return if the cancer is in remission after initial treatment. Some doctors believe the term “continuous therapy” is more appropriate since the cancer is essentially being treated on an ongoing basis.
What Patients With Ovarian Cancer Should Know About Maintenance Therapy
Maintenance therapy is meant to prevent relapse after a patient with ovarian cancer received their main treatment. Heres an overview of what patients should know.
When a patient is diagnosed with ovarian cancer, their initial treatment typically consists of a combination of surgery and chemotherapy, after which most enter remission.
Then the question is, should we consider maintenance therapy? said Dr. Kathryn Pennington, a gynecologic oncologist at the University of Washington, in a presentation at the 12th Annual Joining FORCEs Against Hereditary Cancer Conference.
Understanding the Goals of Maintenance Therapy
Maintenance therapy is the treatment a patient receives after they complete chemotherapy. It is intended to decrease the chance their cancer will return or to delay it from returning. The goal is to continue or maintain, its namesake the successful results of a prior treatment.
When a patient receives maintenance therapy after first-line chemotherapy, it can significantly delay the time of cancer recurrence and avoid the need for second-line chemotherapy. If they do end up having a recurrence after maintenance therapy, maintenance therapy can continue after second-line chemotherapy if patients have a good response.
Maintenance Therapy Options and Recent Approvals
There are several available options for maintenance therapy that have been approved by the Food and Drug Administration in epithelial ovarian cancer, Pennington explained.
Read Also: Pros And Cons Of Radiation Therapy
Efficacy And Safety Of Pemetrexed Maintenance Chemotherapy For Advanced Non
Jianjie Li#, Yujia Chi#, Guang Cao#, Jun Zhao, Tongtong An, Meina Wu, Yuyan Wang, Minglei Zhuo, Xue Yang, Bo Jia, Hanxiao Chen, Jingjing Wang, Xiaoyu Zhai, Ziping Wang
Key Laboratory of Carcinogenesis and Translational Research , Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute , , China
Contributions: Conception and design: Z Wang, J Li Administrative support: Z Wang, J Li Provision of study materials or patients: J Li, T An, M Wu, Y Wang, M Zhuo Collection and assembly of data: J Li, Y Chi Data analysis and interpretation: J Li, G Cao Manuscript writing: All authors Final approval of manuscript: All authors.
#These authors contributed equally to this work.
Background: Pemetrexed maintenance therapy offers a survival benefit in patients with nonprogressive advanced nonsquamous non-small cell lung cancer with good tolerability. This study was designed to analyze the efficacy and safety of pemetrexed maintenance chemotherapy in advanced nonsquamous NSCLC patients in a real-world setting.
Methods: The response rate and adverse events in 71 nonsquamous NSCLC patients treated with pemetrexed-based chemotherapy were observed until disease progression or unacceptable toxicities. Measures of survival were analyzed during follow-up.
Pemetrexed maintenance chemotherapy can improve PFS in patients with advanced nonsquamous NSCLC with good tolerability.
Submitted Dec 30, 2020. Accepted for publication Mar 17, 2021.
How Is Chronic Cancer Treated
Most people want to do anything possible to treat cancer, whether its the first treatment or the second or third one. Your doctor will talk to you about your treatment options. You may also decide to get a second opinion or get treated at a comprehensive cancer center that has more experience with your type of cancer. There may be clinical trials available, too.
Some people get some of the same types of treatment that they had the first time , but some treatments may be less helpful as the cancer progresses. Treatment decisions are based on the type of disease, location of the cancer, amount of cancer, extent of spread, your overall health, and your personal wishes.
You May Like: Pain That Radiates From Back To Chest
Who Benefits Most From Maintenance Therapy
As with most treatments for lung cancer, there are certain people who respond much better than others to therapy.
Studies of Alimta have shown that it seems to be more effective for people with lung adenocarcinoma. In fact, it seems to extend the survival rate significantly in patients with that type of NSCLC who use Alimta for maintenance therapy.
Evidence In Nsclc Questioned
The argument that patients need a chemotherapy holiday to feel better is not a strong one, she said. Patients tend to feel better when theyre on a chemotherapy thats working.Offering a counterpoint during the debate at the Lung Cancer Congress was Glenwood Goss, MD, FCPSA, FRCPC, professor of Medicine and director of Clinical and Translational Research at the Ottawa Hospital Cancer Centre at the University of Ottawa.
Glenwood Goss, MD
Goss noted that, in trials of MT in NSCLC, there are many patients who never make it to the maintenance phase.
In studies of MT for NSCLC, he said, just 30% to 60% of patients who underwent induction therapy were then deemed eligible to receive maintenance. Of those patients, the ones randomized to placebo were more likely, after the study was over, to be eligible for treatment upon progression, Goss said, meaning that maintenance therapy comes at a cost.
Goss added that he hasnt seen convincing evidence that MT works in the disease. In continuation maintenance, he said, PARAMOUNT was the only trial among six large, recent studies to demonstrate a statistically significant survival advantage associated with that approach. Similarly, he said, among three trials of chemotherapy switch maintenance in NSCLC, the JMEN study was the only one to show a statistically significant survival advantage, and SATURN stood alone among six phase III trials of targeted MTs in NSCLC in demonstrating a statistically significant improvement in OS.
Don’t Miss: How Long Do Chemo Treatments Last
Pfs And Os After Different Lines Of Pemetrexed Treatment
The median number of treatment cycles was 8 in 71 patients, and the median PFS was 9.5 months . The median PFS was 10.4 months in 54 patients treated with first-line pemetrexed-based regimen and 8.4 months in 17 patients treated with the second- and higher-line pemetrexed-based regimen . Thirty-nine patients died within follow-up.
Figure 1Figure 2
Univariate and multivariate analyses of the predictors of PFS
Univariate analysis showed that PFS did not significantly differ among patients with different age, gender, smoking history, ECOG score, driver gene mutations , treatment lines, maintenance therapy, and anti-angiogenic drugs . Only two factors significantly affected PFS: number of the cycles of combination chemotherapy and pemetrexed maintenance therapy . The multivariate analysis further confirmed that the number of chemotherapy cycles was an independent factor for PFS.
The median OS was 30.5 months the in 71 patients. The median OS was 37.5 months in 54 patients treated with first-line pemetrexed-based regimen and 53.4 months in 17 patients treated with the second- and higher-line pemetrexed-based regimen .
Univariate and multivariate analyses of the predictors of OS