Maintenance therapy in advanced colorectal cancer, yes or no? Ask the laboratory

In oncology, the concept of maintenance therapy is dependent upon two conditions: the availability of an effective induction treatment preventing a rapid progression and a certain degree of toxicity that does not allow indefinite continuation of therapy. When FU was the only active agent against advanced colorectal cancer we knew that continuing FU chemotherapy beyond 3–5 months (the time to response and maximum response to this agent) was not efficacious [1]. When FOLFOX and FOLFIRI became standard practice (prolongation of median OS beyond 18 months, but added toxicity), investigating less intense ways of prolonging the first line treatment became necessary. Consequently, the on–off FOLFIRI strategy [2] and the intermittent use of oxaliplatin [3] were demonstrated to be equivalent or better than continuing the doublet until progression. This produced the new concept of 'first line strategy' as opposed to the 'first line treatment' concept.

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