1.Chemical therapy will shorten the life time of patients? Before the clinical application of cisplatin, the efficiency of chemotherapy drugs such as CTX, ADM and MMC for advanced non-small cell lung cancer was less than 10%, and the toxic side effects were so great that doing chemotherapy really could not give the patient a longer life time. After the introduction of cisplatin, for advanced (stage IIIB/IV) non-small cell lung cancer, several studies have affirmed the role of systemic chemotherapy, which can improve the symptoms of advanced non-small cell lung cancer, improve the efficacy and prolong the survival compared with best supportive care. In a Meta-analysis of 52 randomized comparative studies comparing best supportive care with chemotherapy, Stewart et al. found that platinum-containing combination chemotherapy reduced the risk of death by 27% and increased 1-year survival by 10% compared with best supportive care, and in a subgroup analysis found that this prolongation was only seen in the cisplatin-based combination regimen. Subsequently, the introduction of gemcitabine, vincristine, paclitaxel, and doxorubicin, there are a large number of clinical studies confirming the role of chemotherapy in prolonging survival time for lung cancer patients, especially the clinical application of pemetrexed, which further improved the efficiency of advanced lung adenocarcinoma cancer, and in the JMDB study, a total of 1725 patients with advanced non-small cell lung cancer were enrolled, and an overall survival of 12.6 months was obtained for lung adenocarcinoma. It is now possible to answer clearly: for advanced non-small cell lung cancer, chemotherapy is superior to best supportive care, and chemotherapy can prolong survival, improve symptoms and enhance quality of life in patients with advanced non-small cell lung cancer. 2.Is chemotherapy better than no chemotherapy for all patients with advanced lung cancer after diagnosis? Although the data from clinical trials confirm that chemotherapy can prolong the life of lung cancer patients, not all of them can benefit from chemotherapy, such as old and frail patients, patients with poor general condition and anemia are not suitable for chemotherapy. Only patients with advanced non-small cell lung cancer in good general condition can benefit from chemotherapy with platinum-containing regimen. Simply put, they should be able to eat, sleep, move around normally and have smooth urination and defecation before they can undergo combination chemotherapy with two platinum-containing drugs. 3.Do all lung cancers need chemotherapy after surgery? Non-small cell lung cancer is a disease mainly treated by surgery. Patients who are able to have surgery should try to have surgery as much as possible, and only with surgical resection can there be a theoretical possibility of cure. However, in clinical practice, many lung cancer patients have recurrence or metastasis soon after surgery alone, and long-term survival cannot be obtained by surgical treatment alone. The GALGB9633 and JBR10 studies presented at the ASCO annual meeting in 2004 provided a theoretical basis for postoperative adjuvant chemotherapy for non-small cell lung cancer, which reduced the 4-year mortality rate of lung cancer patients, and adjuvant chemotherapy containing third-generation chemotherapeutic agents greatly improved the survival rate of lung cancer patients. Since then, after surgery for lung cancer patients, doctors will give advice on postoperative adjuvant chemotherapy to reduce or delay recurrence of metastasis and prolong the overall survival of patients. However, not all patients with non-small cell lung cancer can benefit from postoperative adjuvant chemotherapy. Postoperative adjuvant chemotherapy is not recommended for patients with stage IA, bronchoalveolar carcinoma, total lung resection, poor general condition, slow postoperative recovery from surgical comorbidities, and those who are not suitable for platinum-containing drugs. Postoperative chemotherapy is not recommended for this group of patients, and regular medical review, immunotherapy and Chinese herbal medicine are given. 4.TKI-targeted therapy is better than chemotherapy? TKI-targeted therapy (ERSA, Troche) is a new star in the field of medical oncology in the 21st century, creating a new milestone in the history of advanced non-small cell lung cancer treatment, greatly improving the treatment effect of some advanced non-small cell lung cancer patients, improving their quality of life and prolonging their survival time, opening a new window of life for dying cancer patients. However, not all non-small cell lung cancer patients are suitable for TKI-targeted therapy. Targeted therapy, as the name implies, is aimed at the target for treatment, and is effective with target and ineffective without target. ERSA and Trocet mainly act on patients with tumor tissue positive for EGFR mutation. Clinical trials have confirmed that in non-selected populations worldwide, the therapeutic effect of ERSA and Tricor is less than that of chemotherapy; in superior populations the therapeutic effect of ERSA and Tricor is slightly better than that of chemotherapy, what is a superior population? Both – Asian, female, non-smoking, adenocarcinoma patients; further study found that in the superior population, the positive rate of EGFR mutation is higher than that of non-dominant population, able to do examination with pathological tissue, advanced non-small cell lung cancer patients with positive EGFR mutation can really benefit from the treatment of ERSA and Troche, male, smoking or Patients with squamous carcinoma can also be treated with ERSA and Troche as long as they have EGFR gene mutation. 5.Patients with effective TKI-targeted therapy do not need chemotherapy? Theoretically, advanced non-small cell lung cancer is an incurable tumor, the tumor cells persist in human body, only under the effect of drugs, the growth is inhibited to a certain extent, but after a period of time, the tumor will resurface and grow uncontrollably again, which is clinically known as drug resistance. At this time, the treatment with ERSA and Troche is stopped and replaced by a combination chemotherapy regimen with two platinum-containing drugs. After a few cycles of chemotherapy, the T790M gene disappears and treatment with ERSA and Troche remains effective. The results of the OPTIMAL clinical trial designed by our Chinese experts confirmed that for patients with EGFR mutation-positive disease, the best treatment outcome is obtained by sequential TKI-targeted therapy with chemotherapy, and whether chemotherapy or TKI-targeted therapy is administered first, switching to another treatment regimen once disease progression occurs can prolong the overall survival time of patients. Therefore, for advanced non-small cell lung cancer patients with EGFR mutation, we have two weapons in our hands, one is chemotherapy drugs and the other is TKI-targeted therapy drugs, each of which has corresponding killing effect and, therefore, certain toxic side effects. How to use these two weapons well, maximize the therapeutic effect, minimize the toxic side effects, maximize the therapeutic effect of each weapon, and make the patient’s therapeutic effect appear 1+1 more than 2, this is what our medical oncologists are capable of. Problems, and many more problems, may be solved today’s problems, there are tomorrow’s problems, the day after tomorrow’s problems. Medicine is the process of finding and solving problems.