Successes and Challenges with Maintenance Therapy


Shilpa Gupta, MD and Jason Brown, MD discuss trials with successful or negative results with maintenance therapy.

Jason R. Brown, MD: Overall, this paper highlights a number of trials that we’ve seen in maintenance therapy and there’s been some successes as well as some challenges. Some of the early successes we saw were in lung cancer, for example, the PACIFIC trial which showed not only progression-free survival but also an overall survival benefit of durvalumab following chemoradiation in stage III non-small cell lung cancer. Another major success that we’ve had recently that this paper was not published at the time of but we’ve seen after is the JAVELIN Bladder trial which showed overall survival benefit in avelumab following initial platinum-based chemotherapy for urothelial cancer. Unfortunately, these successes haven’t translated to some other cancers, for example in the JAVELIN Gastric and JAVELIN Ovarian cancer. Like urothelial cancer, these were also trials of switch maintenance with avelumab-based chemotherapy. However, both were shown to be negative.

Shilpa Gupta, MD: Thank you, Jason, for that overview and this brings us to the point of how the disease biology really dictates the effect further therapy will have on the initial chemotherapy treatment. I think we really need to design trials which are based on biomarker-based approach as opposed to blanket treatments.

Jason R. Brown, MD: Yeah, absolutely. Agree completely with that. Biomarkers are really going to be important to determine which subset. We’ve seen a similar story in breast cancer and immunotherapy where we thought breast cancer was the coldest cancer for the longest time, and then we found out in a subset of triple negatives that had PD-L1 [programmed death ligand-1] positivity, that immunotherapy was beneficial. I imagine choosing the right biomarkers in this maintenance strategy might also make us realize what cancers and ultimately what subsets of those cancers.

Shilpa Gupta, MD: Agree certainly.

Transcript edited for clarity.

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