This study, conducted in Brazil, clearly demonstrates an advantage in both short-term treatment benefit and overall survival for patients with PS 2 who received carboplatin/pemetrexed compared to pemetrexed alone. One important parameter that was not reported was whether the poor PS was caused by unrelated comorbidities or the disease itself, and one might anticipate that more aggressive treatment would be more appropriate and effective for patients with relatively recent PS deterioration due to the underlying cancer.