Lung cancer is one of the most common cancers in the world, with 1.2 million new cases each year, of which non-small cell lung cancer accounts for about 80%. Lung cancer is the most deadly cancer in China, with 600,000 patients dying of lung cancer each year. Due to the insidious nature of early stage, most patients with non-small cell lung cancer are already locally advanced or metastatic when they are detected, and more than half of the lung cancer patients will miss the opportunity of surgery. Traditional radiotherapy has limited efficacy and is accompanied by intolerable drug toxic side effects. However, the emergence of targeted drugs has provided a new possibility to conquer lung cancer. Unlike traditional chemotherapy, patients who receive targeted therapy can benefit from long-term survival even if their tumors are stable, therefore, future cancer treatment may develop towards “survival with tumor” or “good survival with tumor”. Another milestone in the treatment of lung cancer – Troche (erlotinib) could extend life: The latest data from the largest phase IV study of non-small cell lung cancer to date, TRUST, were presented at the 33rd Annual Meeting of the European Society of Clinical Oncology (ESMO) this year. These data show that Asian lung cancer patients have a one-year survival rate of up to 60% and can achieve a median progression-free survival time of 25.1 weeks! Once again, it is confirmed that Troche (erlotinib) can bring significant clinical benefit to a wide range of non-small cell lung cancer patients. Unlike conventional chemotherapy, troche stops tumor cell growth by inhibiting epidermal growth factor receptor (EGFR) tyrosine kinase, which is targeted at tumor cells to inhibit their growth and proliferation. Troche delays the worsening of lung cancer-related symptoms such as cough, dyspnea, and pain, avoids the strong side effects such as white blood cell drop, nausea, and vomiting caused by traditional chemotherapy, and only requires once daily oral dosing, significantly improving patients’ quality of life. Targeted therapeutic agents are expected to be used for first-line treatment of non-small cell lung cancer: the PASS study The targeted drug gefitinib is now used for second- and third-line treatment of advanced non-small cell lung cancer. As clinical studies continue, data show that EGFR-TKI (epidermal growth factor tyrosine kinase receptor antagonist) presents a new opportunity for patients. The latest IPASS Phase III study results for first-line treatment of advanced non-small cell lung cancer in Asia were presented at the European Society of Clinical Oncology (ESMO) annual meeting held this year. The data show that oral gefitinib offers an advantage in disease-progression-free survival relative to intravenous carboplatin/paclitaxel combination chemotherapy regimens in an overall population of Asian patients with advanced non-small cell lung cancer selected on the basis of clinical characteristics. The study also demonstrated superior tolerability profile and quality of life improvement rates in the gefitinib-treated group compared to chemotherapy. This bodes well for more Asian patients who are expected to benefit from targeted therapy after their initial diagnosis. AVAiL Study The European Oncology Conference revealed that a study called AVAiL, which confirms the efficacy of bevacizumab as a first-line treatment option for non-small cell lung cancer (NSCLC), the most common form of lung cancer, has helped desperate patients take a critical step toward survival. This study compared the treatment effects of gemcitabine + cisplatin ± bevacizumab. The results showed that PFS was significantly prolonged in the combined bevacizumab group compared with the no-bevacizumab group, even at a low dose (7.5 mg/kg) of bevacizumab, which also prolonged PFS. Notably, patients with squamous carcinoma, low PS score and high risk of bleeding were excluded from both studies for safety reasons. PASS study In September 2008, Prof. Shujin Mok from the Chinese University of Hong Kong, China, representing an Asian research group, presented the preliminary results of the phase III randomized open-label clinical study IPASS at the annual meeting of the European Society of Medical Oncology (ESMO): 1217 patients with advanced lung adenocarcinoma of Asian descent who were non-smokers or light smokers were treated with Gefitinib monotherapy and paclitaxel/carboplatin first-line chemotherapy resulted in superior progression-free survival (PFS), objective effectiveness rate (ORR), and quality of life for gefitinib monotherapy compared with paclitaxel/carboplatin chemotherapy, with similar overall survival in both groups (survival follow-up is ongoing). Detailed dissection of this overall result revealed that the advantage of PFS in both groups changed over time. At the beginning of treatment, PFS was superior in the chemotherapy group than in the gefitinib group, while the gefitinib group showed a PFS advantage at a later stage. A partial answer to this seemingly unexplained phenomenon was found by biomarker analysis of tumor tissue specimens from the enrolled patients. This phenomenon may be due to the fact that patients with different epidermal growth factor receptor (EGFR) mutation status responded very differently to the two treatments: in EGFR mutation-positive patients, PFS was significantly better with gefitinib than with chemotherapy, whereas in EGFR wild-type patients, PFS was significantly better with chemotherapy than with gefitinib.