Role of Maintenance Chemotherapy

Performance status is an attempt to quantify cancer patients general well being. If the patient is performing well (performance status 0-1) and the disease is stable after initial chemotherapy, meaning the size and numbers of tumours remain relatively the same, continuation of pemetrexed treatment is recommended in non-squamousNon-Small Cell Lung Cancer (NSCLC). Pemetrexed is a drug that inhibits production of DNA and RNA and hence prevents cell growth, specifically of cancer cells since they are actively producing DNA and RNA. Non-squamous NSCLC refers to the non-flat shape of cancer cells determined from examinations such as a biopsy, where a sample of the tumour is removed for analysis. This allows doctors to categorize types of cancer.

For patients performing well (performance status 0-1) with non-squamous cancer, if first-line chemotherapy is non-pemetrexed based, a switch to pemetrexed treatment can be considered.

Some cancer cells have proteins on their surface called epidermal growth factor receptors (EGFRs). Gene changes known as mutations can produce abnormal EGFRs, causing cancer. For all patients, switch to erlotinib treatment can be considered, but only if such a mutation in EGFR is detected. Erlotinib is a drug that blocks receptors that stimulate cancer to grow, preventing cancer cell growth.