What is Maintenance Therapy?

Aprobado por la Junta Editorial de Cancer.Net, 05/2022

Maintenance therapy is the ongoing treatment of cancer with medication after the cancer has responded to the first recommended treatment. Maintenance therapy, sometimes called continuous therapy, is used for the following reasons:

  • To prevent the cancer's return

  • To delay the growth of advanced cancer after the initial treatment

Maintenance therapy can be given for long periods of time in either of these situations. A maintenance therapy treatment plan may include chemotherapy, hormonal therapy, immunotherapy, or targeted therapy.

How is maintenance therapy used to prevent cancer recurrence?

For many types of cancer, the goal of treatment is to cure the cancer. After treatment, if doctors cannot find evidence of the cancer remaining in the body, this is called a "remission" or a "complete remission." Even when a person is in complete remission, the cancer can sometimes come back later. If this happens, it is called a recurrence.

Maintenance therapy during remission can help lower your chance of recurrence if you have certain kinds of cancer. For example, in some types of leukemia and lymphoma, maintenance therapy during remission can reduces the risk of recurrence and improves the cure rate. For these cancer types, maintenance therapy is a common part of standard treatment.

Talk with your doctor about if or how maintenance therapy is recommended for the type of cancer you have.

How is maintenance therapy used to treat advanced cancer?

For many types of advanced cancer, the initial treatments can shrink the cancer and prevent it from spreading, but the cancer is not gone. For some of these cancer types, maintenance therapy can delay cancer progression and prolong survival. Maintenance therapy is now commonly used after initial treatment for several advanced cancers, such as advanced lung cancer, colorectal cancer, ovarian cancer, and some types of lymphoma.

When recommended, maintenance therapy can:

Continue treatment similar the initial treatment regimen. For many types of cancer, the first treatment is combination chemotherapy. This is a treatment plan that includes more than 1 type of chemotherapy. This kind of treatment regimen can be intensive and it may be difficult to have for long periods of time due to the potential for severe side effects. If the combination chemotherapy treatment is still working to treat the cancer, the regimen can be modified over time. This is considered a "maintenance regimen."

Side effects from maintenance regimens are often easier to manage than those from the intensive initial treatment. And if needed, there are different ways your doctor can modify the original treatment plan:

  • Reducing the number of drugs in the combination

  • Lowering the dose of each drug

  • Changing how often the patient receive doses

  • Substituting similar drugs that may cause less side effects

Using this type of maintenance therapy can provide the full benefit of the initial treatment with fewer side effects.

Introduce new medication into treatment. Adding a new drug that works in a different way can continue to shrink the cancer after the initial treatment. This approach is sometimes called "switch maintenance." Usually this involves switching from chemotherapy to another type of treatment, such as immunotherapy or targeted therapy. As additional active drugs are identified and approved, it is likely that more types of cancer will benefit from this type of maintenance therapy.

How long will I receive maintenance therapy?

How long you receive maintenance therapy depends on many factors. When used for potentially curable cancers during remission, maintenance treatment is given for a specified length of time, usually between 6 weeks and 2 years. When used to control advanced cancer, maintenance therapy can continue for as long as the cancer does not change or grow if the treatment does not cause too many side effects. Some of the factors that your health care team will consider include:

  • The type of cancer

  • The drugs used

  • How well the treatment is working over time

  • The number and severity of side effects

Is maintenance therapy a new kind of cancer treatment?

No. But maintenance treatment has been proven to extend survival in more types of cancer than in the past. Maintenance therapy is now more effective and feasible for many types of cancer because:

  • The number of effective drugs for most types of cancer has increased because of ongoing advances in cancer research. It is not possible to use all of the effective drugs together as part of the first-line treatment, due to causing too many side effects. However, giving different drugs immediately after the initial treatment has achieved its maximum effect has improved survival in some types of advanced cancer. In general, the biggest impact from maintenance treatment is seen when a drug with a completely different way of attacking the cancer cell is introduced during maintenance therapy (see "switch maintenance", above).

  • New cancer drugs often have fewer side effects than older ones. This means that people may be able to take them longer.

Cancer survivors have different feelings about maintenance therapy. Some people feel safer taking maintenance therapy. But others may feel that they are not a "cancer survivor" if they are still receiving ongoing treatment. Learn more about survivorship, including the challenges of receiving extended treatment. And, talk with your health care team about finding emotional support that is right for you.

Questions to ask your health care team

Consider asking the following questions about maintenance therapy:

  • Is maintenance therapy recommended for me? Why or why not?

  • What type of maintenance therapy do you recommend?

  • What are the potential benefits and risks of this treatment?

  • How often would I get maintenance therapy? For how long?

  • Where would I receive this treatment?

  • Will the side effects be similar or different from my initial cancer treatment? What can I expect?

  • Who should I talk with about side effects I experience? How soon?

  • Are there long-term side effects of this treatment?

  • Will my insurance pay for it? Who can I talk with about the cost of this treatment?

  • When is watchful waiting a better option? (Watchful waiting or "active surveillance" is watching for signs that cancer is coming back. You only start treatment if symptoms develop.)

  • What maintenance therapy clinical trials are available for me, and how do I find out more about them?

Related Resources

Coping With Fear of Recurrence

Dealing With Cancer Recurrence