Histologically customized and maintenance chemotherapy in advanced non-small cell lung cancer

Non-small cell lung cancer is considered an elusive and resistant disease to antiblastic agents. All the patients eventually progressed after the exposure to first line chemotherapy due to the rising of clonal resistant cells that became refractory to conventional treatments. In the past, patients who did not progress to first line chemotherapy were put on stand-by strategy, mainly because of the lack of effective therapies. The maintenance strategy is a true revolution in the oncology landscape. In non-squamous tumors, pemetrexed and bevacizumab maintenance have been reported to improve the median disease progression survival of metastatic patients after the completion of standard first line chemotherapy. This new approach of switched or continued maintenance therapy led to almost two years overall survivals in nononcogene- addicted NSCLC, which raises the bar two folds in comparison to standard strategy. The discovery of the oncogene addiction phenomenon and the instauration of maintenance therapies have changed the landscape of lung cancer treatment. The cost-effectiveness balance of the maintenance strategy and the affordability for the public health systems, how to select the right population if any, the management of a new soft toxic profile, and the long term maintenance of treatment in old and frail patients are issues to be discussed, and they will be exhaustively analyzed in the present chapter.