Clinical treatment of non-small cell lung cancer has basically entered the stage of precision medicine. With the introduction of targeted drugs and the discovery of more lung cancer driver genes, molecular diagnosis has become increasingly important for clinical diagnosis and treatment, and targeted therapy guided by lung cancer driver gene testing has prolonged patient survival. In recent years, our exploration has focused on how to enable better treatment outcomes and survival for patients with positive driver genes, such as using multidisciplinary combination therapy and exploring combination therapy strategies. In the post-EGFR era, the post-treatment of TKI resistance, the clinical application of dynamic biopsy technology, and the exploration of treatment strategies to further improve the survival of driver gene-positive patients are the goals of precision therapy. Successive generations of oncologists considered tumors as immune diseases, and it was only in 2013 that breakthroughs were made in immune drug therapy for common tumors, and several studies reported from 2013 to 2015 showed breakthroughs in immunotherapy for solid tumors. Currently, immunotherapy faces the following difficulties: ① the efficacy of immunotherapy is currently only 20%, the remaining 80% of patients why the efficacy is not good, and the mechanism of primary and secondary drug resistance should be further explored in the future. ②Explore the biomarkers of immunotherapy. A portion of PD-L1 negative patients can also benefit from immunotherapy, and PD-L1 may not be feasible as a biomarker. ③Immunotherapy drugs are expensive, and more precise use of immunotherapy drugs and lower medical costs are future research directions. The therapeutic value of EGFR-TKI for NSCLC brain metastases The incidence of brain metastases in non-small cell lung cancer (NSCLC) is high, with 10% of patients initially diagnosed having brain metastases and 30% to 40% of patients developing brain metastases during treatment. There is no international consensus on the best treatment strategy for brain metastases from NSCLC. We need to emphasize three points: first, TKI is effective in the treatment of NSCLC brain metastases; second, patients with brain metastases need to be categorized, and patients with obvious symptoms of brain metastases need standard treatment, such as whole brain radiotherapy, SRT and surgery; patients with asymptomatic NSCLC brain metastases can be treated with TKI-targeted therapy alone; third, we need more research data to support. Professor Yilong Wu initiated the phase III BRAIN study for patients with brain metastases to verify whether first-line treatment of brain metastases with exatinib is comparable to standard radiotherapy, and the results of the study may change clinical practice. How to further improve the efficacy of targeted drug therapy In recent years, basic and translational research on TKI resistance has identified several TKI resistance mechanisms, such as T790M mutations, C-met gene amplification, epigenetic alterations, and cell phenotype mutations. Thanks to advances in pathological detection techniques (e.g., liquid biopsy techniques), we can discover information about a patient’s cancer months before his or her clinical progression and identify pathological alterations in patients earlier than the real changes in their histological organs. Therefore, there are two ways to solve the problem of TKI resistance: (i) explore the resistance mechanism of targeted drugs at the stage of conducting basic drug research, and design strategies to deal with resistance at the stage of laboratory research to achieve a proactive effect. ② In clinical treatment, advanced pathological detection technology is used to detect the possibility of drug resistance in patients in advance, so that patients can enter the effective treatment pathway early. The role and positioning of EGFR-TKIs in postoperative adjuvant therapy for NSCLC We have long explored the position of EGFR-TKIs in postoperative adjuvant therapy for NSCLC. Early studies of postoperative adjuvant therapy with EGFR-TKIs did not distinguish between mutated and non-mutated patients, and the results were negative; studies of mutated patients to date have not found an increased OS benefit with adjuvant therapy with EGFR-TKIs. whether adjuvant therapy with EGFR-TKIs can benefit patients should probably not be based on 5-year OS results, but may need to refer to 7- and 8-year OS data. Several trials of postoperative adjuvant therapy with EGFR-TKIs have been conducted by domestic scholars (Prof. Yilong Wu, Prof. Yue Yang, etc.), including the postoperative adjuvant targeted therapy study with exatinib, but these studies take a long time to reach conclusions, and the application of EGFR-TKIs in postoperative adjuvant therapy in NSCLC is still being explored. Compared to targeted therapy studies in patients with advanced NSCLC, it is quite difficult to conduct postoperative adjuvant EGFR-TKI therapy studies in early stage patients, especially when OS is considered as an indicator. The results of the studies are influenced by several factors, such as the continuous application of new drugs and the advancement of new medical treatments. We should be cautious and objective about the results of post-operative adjuvant therapy studies with EGFR-TKI. Prospects of targeted drug development for non-small cell lung cancer in China As clinical oncologists, we should use the available tools to make the best survival for patients. Clinical oncologists should do a good job of integrated treatment, treating not only the tumor but also the tumor host during the treatment process, which is the idea to improve the treatment outcome. ①We should emphasize integrated treatment and focus on the combined application of multiple therapeutic tools. On the basis of effective targeted therapy, the combined application of multiple effective therapies can enable patients to obtain longer PFS, and the prolonged PFS obtained by the first treatment has a great impact on the overall survival of patients. ②We should pay further attention to new drug development and alternative drug development, such as follow-up treatment of targeted therapy and drug development against drug-resistant mutations. ③We should pay attention to the R&D of small molecule targeted drugs targeting low frequency driver genes. For example, in the R&D of targeted drugs for lung cancer, Beda Pharmaceutical has carried out or will carry out the R&D of C-met inhibitor, BPI-15086 for T790M resistance mutation and ALK inhibitor. First, new drug development is continuously ongoing, and targeted drugs are subject to drug resistance, so new drugs should be further developed for drug resistance mechanisms. Second, rare targets are constantly discovered, and new drug research is necessary for rare targets in order to improve the therapeutic effect. Third, immunotherapy and targeted drug development need to be focused on, and there are already many effective therapeutic drugs, but there are still many unresolved issues, such as the issue of biomarkers for immunotherapy. We need to solve these problems to give patients more accurate treatment. Advances in clinical oncology, especially in lung cancer internal medicine, depend on advances in drug development. In terms of drug discovery and development, I think China will experience 3 decades of development. From 1999 (when the CFDA was established in 1998) to 2009 (when the Chinese patient-led IPASS study was published, marking the beginning of Chinese clinical trials to the world), China was a trendsetter in new drug development, learning from the West. The results of Chinese new drug development and Chinese investigator-led clinical studies have been reported in international conferences one after another. I also believe that in the decade after 2019, China will become a leader in new drug development and lead the international advancement of lung cancer medical treatment.