Sequential, alternating, and maintenance/consolidation chemotherapy in advanced non-small cell lung cancer: A review of the literature

Francesco Grossi, Marianna Aita, Alessandro Follador, Carlotta Defferrari, Annalisa Brianti, Graziella Sinaccio, Ornella Belvedere

Research output: Contribution to journalArticlepeer-review


A platinum-based doublet with a third-generation agent (paclitaxel, vinorelbine, gemcitabine, docetaxel) represents the standard first-line treatment for advanced non-small cell lung cancer patients with good performance status (PS). Traditional chemotherapy provides response rates of 20%-40%and a median survival of 8-10 months. In an attempt to improve its outcome, alternative schedules have been proposed, namely sequential, alternating, and maintenance/consolidation therapy. Sequential chemotherapy with a platinum-based doublet followed by a single agent is feasible in patients with good PS; preliminary results from randomized phase III trials with combination chemotherapy as a comparator are promising, suggesting similar efficacy and a better toxicity profile for the sequential arm. The use of sequential single agents is an option for elderly and frail patients unsuitable for a platinum-based combination. Based on trials published so far, it is unlikely that an alternating chemotherapy strategy will be proven superior to standard chemotherapy in patients with good PS. However, sufficient evidence exists that it could be appropriate in the elderly or in unfit individuals. Consolidation/maintenance chemotherapy may provide additional benefit for patients achieving disease control after standard first-line chemotherapy. Better results are seen when maintenance consists of an agent that has proven active in the induction phase. Further evaluation of this strategy, as well as of consolidation/maintenance therapy with targeted agents, is warranted. In conclusion, these approaches may improve the outcome in selected patients with advanced non-small cell lung cancer, but further results from randomized trials are needed. In the meantime, sequential, alternating, and maintenance/ consolidation therapy should still be considered investigational.

Original languageEnglish
Pages (from-to)451-464
Number of pages14
JournalThe oncologist
Issue number4
Publication statusPublished - 2007


  • Advanced non-small cell lung cancer
  • Alternating chemotherapy
  • Chemotherapy design strategies
  • Maintenance/consolidation chemotherapy
  • Sequential chemotherapy

ASJC Scopus subject areas

  • Cancer Research
  • Hematology


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