One of my patients with mesothelioma recently asked me about maintenance chemotherapy. Specifically, he asked if it was necessary.
When you’re discussing maintenance chemotherapy with a patient, it’s usually a cause for celebration because it means you have control of the cancer.
Maintenance chemotherapy, in general, means a less intensive chemotherapy program that is used after the completion of a full course. The purpose, like the name suggests, is to maintain the achieved shrinkage of the cancer and prevent it from growing back.
There are several ways to do maintenance chemotherapy. One way is maintaining one of two chemotherapy agents you were using while dropping the other. If you had started with Alimta plus carboplatin, you drop one (carboplatin) and keep using Alimta. Sometimes, it’s just using a lower dose, or it’s switching to a different treatment.
In the past, maintenance chemotherapy was not recommended for most solid tumors because excessive side effects from the treatment outweighed the potential benefits.
That has changed, though, in recent years. Patients with advanced lung cancer, for example, who continued on maintenance chemotherapy programs have shown to have better results than those who stopped chemotherapy.
The question comes up with mesothelioma because there still is no clinical trial out there showing the benefit of maintenance chemotherapy. We can’t say for sure that it is beneficial. With lung cancer, there is a wealth of information about it. With mesothelioma, there is absolutely none.
Because mesothelioma is such a rare cancer, it’s tough to do a study. There are just a small number of patients when compared with other cancers.
One benefit of maintenance chemotherapy for mesothelioma, even if we don’t know for sure the benefit, is that a patient is being seen by a doctor on a regular basis. If there is a recurrence of the disease, you tend to find out a lot sooner. If there is no maintenance — and there is recurrence — a patient often doesn’t see the doctor again until it’s too late. By the time the patient finally comes back, he’s too sick to start chemotherapy again.
My advice is that if you do not have a lot of adverse side effects from the chemotherapy, maintenance treatment is reasonable. If you try maintenance and have a lot of trouble, then you stop.
Maintenance therapy can be an open-ended treatment. We have a lung cancer patient who has been using it for almost five years out now. We have a mesothelioma patient who has been on it for more than two years now, and he has tolerated it well.
The man with mesothelioma is disabled. He was in a car accident years ago, and he’s still managing well on the chemotherapy. He wheels himself in, and he looked fine when I saw him recently. It’s really something. He has had great success with the maintenance program.
Maintenance usually means we have control of the disease, and we’re trying to stop it altogether. My personal opinion would be to try and maintain. Unless side effects or quality of life becomes a problem, I think the continuation of maintenance treatment until it doesn’t work anymore is justifiable.
Dr. Tawee Tanvetyanon is an oncologist at the H. Lee Moffitt Cancer Center in Tampa, Florida. He provides guest blogs to give our readers a better understanding of mesothelioma from a doctor’s viewpoint.