Maintenance therapy
Ongoing, gentler treatment given after the main course has shrunk the cancer, to hold it in check for as long as possible rather than to shrink it further.
Maintenance is standard in several settings: PARP inhibitors after platinum chemotherapy in ovarian cancer, pemetrexed or immunotherapy after induction chemotherapy in lung cancer, lenalidomide after transplant in myeloma, and rituximab in follicular lymphoma. The rationale is that the disease remaining after induction is small and slow-growing, so a tolerable long-term drug can delay progression by months or years, while the cost is cumulative side effects and expense during a period when the patient feels well. Trials of maintenance measure progression-free survival above all, and whether they extend overall survival is often debated.
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