• Phase III study (N = 539) evaluating continuation maintenance pemetrexed vs placebo
• Improved OS (median OS 13.9 vs 11.0 mo) and 40% reduction in risk of disease progression
• Maintenance pemetrexed associated with Grade 3 and 4 fatigue (4.7% vs 1.1%), anemia (6.4% vs 0.6%) and neutropenia (5.8% vs 0%)

This landmark study is a classic demonstration of the benefits observed with so-called continuation maintenance — in this case with pemetrexed after induction with cisplatin/pemetrexed — and this report documents a clear-cut improvement in survival with that approach after previous presentations demonstrated an advantage in PFS. Additional information can be gleaned from this data set, including the need for careful monitoring of patients because continuation maintenance for prolonged periods can result in toxicities, particularly fatigue, which is perhaps the most common cumulative side effect.