Maintenance therapy: suppressing tumors with highly effective and low-toxic drugs Maintenance therapy is a new concept in the field of comprehensive treatment of recurrent and metastatic tumors at present. Recurrent and metastatic tumors are the difficult part of current tumor treatment. The traditional treatment phase is very obvious, after the end of first-line treatment such as palliative surgery or radiotherapy, it often means that the treatment has come to an end. Only when recurrence and metastasis occur again will second-line or even third-line treatment be considered. In this way, the treatment situation is often passive, and even some patients are unable to receive further anti-tumor treatment at this time for various reasons, losing many opportunities to control the tumor. The result is that the survival time and quality of life of patients are not very satisfactory. In fact, the idea of maintenance therapy has been around for a long time, but it could not be implemented due to the high toxicity and poor efficacy of previous chemotherapy drugs. In fact, the idea of maintenance therapy has been around for a long time, but could not be implemented due to the high toxicity and poor efficacy of chemotherapy drugs in the past. With the introduction of high-efficiency and low-toxicity anti-tumor drugs in recent years, especially the massive use of targeted drugs in the clinic, this idea has a new hope. Simply put, maintenance therapy means that after the end of conventional chemotherapy, cancer cells are kept in a suppressed state through the continued use of some low-toxic and high-efficiency drugs, which can prolong the survival of tumor patients and improve their quality of life”. Gao Yong introduced that the concept of maintenance therapy is divided into two types: continuation of maintenance therapy and maintenance therapy with drug change. The former refers to the continuation of treatment with at least one effective drug used in the first-line treatment if there is no disease progression after the first-line treatment (4-6 cycles). The latter refers to the continuation of treatment with a drug not included in the first-line regimen if no disease progression occurs after first-line treatment, and “the drug selection for maintenance therapy should have the characteristics of single agent effectiveness, low side effects, and ease of use.” Maintenance therapy is now part of the standard treatment for lung cancer, and the main drugs used are chemotherapy drugs and targeted drugs. In 2008, a randomized, double-blind, multicenter phase III clinical study evaluating maintenance therapy with the chemotherapeutic agent pemetrexed was presented at the ASCO (American Society of Clinical Oncology) annual meeting by US oncologists Ciuleanu et al. The results found that maintenance therapy with pemetrexed resulted in a particularly significant survival benefit in patients with non-squamous lung cancer: median survival was 15.5 months in the drug maintenance group and 10.3 months in the placebo group compared to 10.3 months in the placebo group, with a 30 percent reduction in the risk of death. Pemetrexed has therefore been approved in the US and EU for the maintenance treatment of non-squamous cancer patients whose disease has not progressed after first-line treatment, and is recommended in the NCCN guidelines, the most authoritative international body. In 2009, Cappuzo et al. reported the preliminary results of a multicenter phase III study of maintenance therapy with the targeted drug erlotinib (Troche) at the ASCO annual meeting. Analysis of the study showed that patients of different genders, pathological types, ethnicities, smoking status, and EGFR wild type or mutation benefited from erlotinib maintenance therapy. This was particularly evident in patients with non-squamous cancer: median survival was a statistically significant 13.7 months in the drug maintenance group and 10.5 months in the placebo group. In addition, this maintenance treatment also delayed the onset of pain and the use of painkillers in patients. 2011, our scholar Tension reported a phase III clinical study on maintenance treatment with the targeted drug gefitinib (ERSA), which found that maintenance treatment with gefitinib reduced the risk of death in lung cancer by 58%, and for a specific population (EGFR mutation), the disease progression-free time (PFS) even reached 16.6 months, a highly significant difference compared to 2.7 months in the control group, and was well tolerated by patients. Maintenance therapy PK survival with tumor Some people may say that the concept of survival with tumor is also included in the concept of oncology treatment, but the drug maintenance therapy only improves survival by a few months compared with the placebo group, and the treatment cost is very expensive, so how much does it benefit patients? Maintenance therapy brings hope for more cancer patients to survive with tumor, “compared with decades of life, the increase of a few months is really not significant, but compared with the original lung cancer survival of only 5-6 months, the extension of a few months of survival is very significant, and for some of the appropriate people, it may not be a matter of a few months. The extension of survival in a few months is significant compared to the 5-6 months of survival for some of the appropriate people. In terms of cost of treatment, the cost of maintenance therapy is actually roughly comparable to that of conventional therapy, but the patient’s quality of life is significantly improved during this period. The administration of drug maintenance therapy has significantly reduced or delayed the occurrence of cancer pain, thus improving the quality of life of patients. These factors are the reasons why the maintenance treatment model is endorsed by the modern oncology clinical medicine community. Moreover, the concept of survival with tumor cannot be denied, and there is no contradiction between them. “For those tumors that progress slowly, such as breast cancer, tumor stability can be maintained for months or even years by taking endocrine therapy drugs, which is actually maintenance therapy in a sense, while for tumors that progress faster, such as lung cancer, aggressive treatment may be a better choice. Otherwise the patient’s survival may be significantly shortened by the negative posture of the treatment”. As for how to choose maintenance drugs, Gao believes that besides considering the patient’s general condition, willingness and economic conditions, the most important thing is to choose and weigh the advantages and disadvantages according to the patient’s specific situation, which involves another concept in comprehensive treatment – individualized treatment. -Individualized treatment. Individualized treatment is the opposite of standardized treatment based on evidence-based medicine, but it is certainly not the negation of standardized treatment. Standardized treatment is the construction of a procedure and framework based on evidence-based medicine from the perspective of a large population. Individualized treatment is also based on evidence-based medicine and further subdivided by the genetic type of the tumor, and its treatment is often linked to the use of targeted drugs to make the treatment more effective and with fewer side effects, thus greatly improving the survival and quality of life of patients. Nowadays, lung cancer is not just one disease, but now it seems to have at least five or six different genotypes. The combination of lung cancer of different subtypes with different stages of progression, different age stages and other factors can produce many different treatment plans, and such individually designed treatment plans are individualized treatment. “Different treatment measures are adopted for different stages of tumor progression, such as surgery and radiotherapy for early stage tumors, radiotherapy or palliative treatment for mid- to late-stage tumors, and different drugs for patients at different age stages, which are the scope of individualized treatment, but belong to the ‘primary stage’. ” The real in-depth individualized treatment depends more on the understanding of the tumor itself and the study of tumor genotyping. He cited two examples. The presence or absence of mutations in the EGFR gene in non-small cell lung cancer, and the suitability of the targeted drug Troche for patients with mutations in that gene, which can extend survival to twice as long. Therefore, for patients with EGFR gene mutation, we should choose Troche instead of traditional chemotherapy drugs, which is an individualized form of treatment. Another example is breast cancer, patients with positive ER, PR are suitable for endocrine therapy, and the drugs used for this group of patients before and after menopause are different. patients with positive HER2 gene expression are suitable for the targeted drug Herceptin. “Individualized tumor treatment depends on the research of tumor staging, which needs to be supported by the conclusion of standardized clinical trials. the more in-depth the research is carried out and the more relevant drugs are developed, the better the individualized treatment will be carried out.” Among the current tumors, lung cancer, breast cancer, colorectal cancer and other staging studies are more in-depth, and individualized treatment is carried out better; however, staging studies on pancreatic cancer are rare. However, individualized cancer treatment is a major trend, which is the inevitable result of further understanding of tumor. “Psychological intervention for cancer patients is more effective In the comprehensive treatment of tumor, the emotional and mental state of patients will also have an important impact on their future survival and quality of life. In recent years, there have been news of cancer patients jumping to suicide in Shanghai tertiary hospitals from time to time. “Patients have emotional depression period in the early stage of treatment, they do not understand their disease, do not understand the treatment, lose confidence in the future, even troubled by family emotional factors”, Gao Yong said, the depression and anxiety inside tumor patients, if not resolved in time, may develop into a psychological crisis, even into a tragic suicide. This shows that psychological intervention for tumor patients is also an important part of comprehensive tumor treatment. According to Gao Yong, the role of tumor volunteers can be directly reflected in the treatment, “the most direct effect of negative attitude of tumor patients is that they do not cooperate with the treatment, which makes the disease progress faster; and the psychological guidance work of cancer volunteers can, to a large extent, make the patients’ attitude change and cooperate more actively with the medical staff’s treatment”. In addition, the psychological intervention of volunteers can change patients’ emotions and make pessimistic emotions optimistic, thus improving the quality of patients’ survival to a greater extent.