ONCAlert | 2017 San Antonio Breast Cancer Symposium
Lung Cancer Case Studies

Mark Kris, MD: Maintenance Strategies

Mark Kris, MD
Published Online:Apr 27, 2016
RP is a 72 year old whose past medical history is notable for hypertension (well-controlled), hyperuricemia, and gout. He presents to his PCP with fatigue, progressive dyspnea, and a persistent, nonproductive cough of approximately 1 month's duration. He is a former smoker and quit approximately 30 years ago.

mNSCLC with Mark Kris, MD and Mark Socinski, MD: Case 1



What maintenance strategy would you consider for a patient like this?

So assuming that the patient received three agents and two of those were pemetrexed and bevacizumab, my recommendation would be to continue both pemetrexed and bevacizumab after the initial cycles. To me, maintenance therapy is a true no-brainer. At the end of your induction, however you define it, whatever drugs you choose, you then make an assessment, did these drugs help the patient. And you could answer that yes or no using objective and subjective criteria of your own. You then can ask is this drug safe at this point. And the third question is does this drug make sense to the patient who’s receiving it, and at the end of induction, you ask those three questions, and if the answer to all those things are that it’s effective, it’s safe, and the patient feels it’s helped them and makes sense for them and where they are in their lives, those drugs should be discontinued(?). And, in the case of this patient, it would be continuing both pemetrexed and bevacizumab.

There was a clinical trial done that looked at survival from the start of therapy for different kinds of maintenance, bev alone versus pem plus bev. And, in general, that did not change overall survival, but where the overall did change is for those patients eligible for maintenance. Those that got the two drugs, pem and bev over bev alone, they had a median overall survival of a couple of months more which is an important benefit in our patients. So maintenance makes great sense, and it should never be given unless you ask those three questions and the answers are all yes. Did the patient’s cancer shrink? Was the drug given safely? And did the patient feel that this was an appropriate treatment for them in their lifestyle?

mNSCLC: Case 1

RP is a 72 year old whose past medical history is notable for hypertension (well-controlled), hyperuricemia, and gout. He presents to his PCP with fatigue, progressive dyspnea, and a persistent, nonproductive cough of approximately 1 month’s duration. He is a former smoker and quit approximately 30 years ago.

  • Chest X-ray in October 2015 showed a large mass in the upper left lobe and CT scan showed a left pleural effusion and enlargement of the left mediastinal and hilar lymph node.
  • MRI of the brain was negative for intracranial metastases.
  • The patient underwent resection of the primary mass which showed large cell carcinoma. Pleural fluid was tapped and also positive.
  • His lung cancer was staged as 4. His biopsy was sent for molecular testing and showed no actionable mutations in EGFR or ALK.
  • His current performance status is 1.
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