Maintenance therapy is the use of ongoing chemotherapy (the use of drugs to kill cancer cells) or other treatment to help lower the risk of the cancer coming back after the first treatment. It also may be used for patients with an advanced cancer that has no cure to help keep the cancer from growing and spreading further.

Although the concept of maintenance therapy is not new, its use is growing. One reason is that new cancer drugs have fewer side effects, and patients may be able to take them longer. Also, new research shows maintenance drugs can help some patients with cancer delay a recurrence (return of cancer) or live longer.

Maintenance therapy for cancer remission

Maintenance therapy has long been a treatment approach for people with acute lymphocytic leukemia (ALL) and acute myeloid leukemia (AML). It is given after induction (initial) chemotherapy to keep the cancer from returning. Once there is no more evidence of cancer, lower doses of chemotherapy are given for two to three years.

Maintenance therapy in advanced cancer

For patients with cancer that has grown and spread to other parts of the body, maintenance therapy may help control the disease, allowing patients to live longer.

One clinical trial (research studies involving people) studied the use of the drug pemetrexed (Alimta) after standard chemotherapy for patients with advanced non-small cell lung cancer (NSCLC). The patients who received pemetrexed lived three to five months longer than those who did not get the drug. However, patients with the squamous cell subtype of NSCLC did not live longer with this maintenance treatment. Pemetrexed is the first drug approved by the U.S. Food and Drug Administration (FDA) for maintenance therapy for advanced lung cancer. Despite the improved survival for many patients, it is unclear if this longer treatment lessens cancer symptoms or improves quality of life.

Researching maintenance therapy

Doctors are also using or studying maintenance therapy in these cancers.

• Colorectal cancer
  
  
• Melanoma
  
  
• Multiple myeloma
  
  
• Non-Hodgkin lymphoma
  
  
• Gynecologic cancers: ovarian, fallopian tube, and peritoneal (cancer of the tissue that lines the abdominal wall and covers organs)

For many types of cancer, maintenance therapy is not yet the standard of care, and its use has shown a mixed rate of success in clinical trials. An example is ovarian cancer.

No study to date has found that patients with ovarian cancer live longer if they receive maintenance therapy. But, one study found that maintenance therapy with paclitaxel (Taxol) slowed the growth and spread of cancer, compared with the standard treatment.

In other research, maintenance therapy for metastatic breast cancer (breast cancer that has spread) did not help women live longer. Future research should help clarify the benefits of maintenance therapy. More research is also needed to find the best drugs and treatment schedules for this approach.

What to expect

Often, maintenance therapy involves standard chemotherapy, but at lower doses than for induction chemotherapy. Or, it may use therapeutic (treatment) vaccines, hormone therapy, or other drugs. For example, some women with some types of breast cancer receive hormone therapy to lower the risk of cancer returning. Maintenance therapy may include a drug used in the first treatment plan, another drug, or a combination of drugs.

Depending on the type of cancer and the drugs used, maintenance therapy may last for weeks, months, or years. Whether the treatment works and how long a patient can tolerate side effects also will decide the length of therapy. The frequency of treatment varies, too. It tends to be given with less intensity, either less often than the first chemotherapy and/or at lower doses than were first given.

Benefits and risks

If maintenance therapy is an option for you, talk with your doctor about the potential benefits and risks. One benefit is that it may prevent your cancer from returning or may slow its growth.

On the other hand, here are some possible disadvantages.

• Increased side effects
  
  
• Higher treatment costs
  
  
• More doctor’s visits
  
  
• Limited data on survival benefit
  
  
• Drug resistance (a drug may stop working after long use)

Maintenance therapy as a cancer survivor

The growing use of maintenance therapy may bring new questions as to when people consider themselves a cancer survivor. For some people, receiving maintenance therapy after the first treatment may provide a sense of reassurance. However, other people may struggle to see themselves as a “survivor” if they are still receiving any type of treatment. Regardless of where a person views oneself in the stages of cancer treatment, starting maintenance therapy is an important step forward in a treatment and recovery plan.

What to ask your doctor

Consider asking your doctor the following questions about maintenance therapy.

• Is maintenance therapy an option for me?
  
  
• Do you recommend maintenance therapy?
  
  
• If so, what are the benefits and risks?
  
  
• How often and for how long would I receive treatment?
  
  
• Does my insurance cover this treatment?
  
  
• When is watchful waiting (checking for recurrence, with no treatment) a better choice?
  
  
• What clinical trials are open to me?

More Information

Understanding Chemotherapy

Types of Treatment

Last Updated: February 22, 2010