Problems involved in the clinical trials for non-small cell lung carcinoma

Along with changes in smoking habits, non-small cell lung carcinoma (NSCLC) has come to account for about 90% of all cases of lung cancer. For the treatment of NSCLC, cytocidal antineoplastic drugs such as pemetrexed and molecular-targeted drugs such as gefitinib, erlotinib, and bevacizumab have been approved globally and used as a part of the standard treatment. The importance of better patient selection based on the optimum indication of these drugs is attracting much attention. Additionally, timing for the use of these drugs also seems to be an important issue. The present review presents a critical discussion about the following issues based on the results of clinical studies: (1) whether or not the assessment of the EGFR mutation status in NSCLC patients is indispensable; (2) whether gefitinib and erlotinib have different effects; (3) the need to sub-classify NSCLC by histologic type; (4) significance of maintenance therapy for NSCLC; and (5) whether platinum-doublet chemotherapy plus bevacizumab is a standard treatment for non-squamous cell carcinoma.