Maintenance is usually defined as treatment to maintain a complete resonse or best achievable partial response but not therapy that aims to improve response. Unfortiunately most patient who achieve response in metastatic disease and many in stage III, ultimately relapse. Maintenance could potentially benefit these patients. There have been several studies with conflicting results. One by Markman et al showed prolongation of disese free survival. A 2003 review stated: "Prospective randomized trials of maintenance strategies should also incorporate formal quality-of-life assessments. Until the completion of additional trials, the results of the study by Markman et al should not routinely be used to recommend maintenance paclitaxel in patients with advanced ovarian cancer who have achieved a complete remission with standard". In 2nd line, Doxil has not shown benefit for maintenance. NCCN recommends paclitaxel maintenance as a 2B option and the discussion states that the experts on the panel disagree about this. Kaye S, Vasey P. Docetaxel in ovarian cancer: phase III perspectives and future development. Seminars in Oncology. 2002;29(3 Suppl 12):22-7.
Ozols, Robert F. Maintenance Therapy in Advanced Ovarian Cancer: Progression-Free Survival and Clinical Benefit J Clin Oncol 2003 21: 2451-2453
Markman M, Liu PY, Wilczynski S, et al. Southwest Oncology Group; Gynecologic Oncology Group. Phase III randomized trial of 12 versus 3 months of maintenance paclitaxel in patients with advanced ovarian cancer after complete response to platinum and paclitaxel-based chemotherapy: a Southwest Oncology Group and Gynecologic Oncology Group trial. J Clin Oncol 2003;21(13):2460-2465.
E Andreopoulou et al, Pegylated liposomal doxorubicin HCL (PLD; Caelyx/Doxil®): Experience with long-term maintenance in responding patients with recurrent epithelial ovarian cancer Ann Oncol (2007) 18 (4): 716-721.