The PARAMOUNT trial in NSCLC: is the amount of benefit clinically meaningful?

The PARAMOUNT study recently updated for survival analysis, showed that continuous maintenance with pemetrexed (P) lead to a 3 months overall survival (OS) benefit in non-small cell lung cancer (NSCLC) patients not progressing after P-based induction chemotherapy. The conclusion are that, continuing P alone up to progression of disease, is better that stop chemotherapy after 4 cycles of cisplatinum/P doublet, at the expense of a slightly worst toxicity compared to placebo arm, and no worsening of quality of life. If the benefit in this population of performance status 0-1 (and nonsquamous histology) subjects, would have been the same with reintroduction of P (or with any active second line available) at the progression of disease, is a matter of debate. Appropriate randomized trials are ongoing and will answer to this question.