the American Society of Clinical Oncology Clinical Practice Guidelines 2009 suggest frontline use of gefitinib for people with activating EGFR mutations. If FAAH inhibitor mutation is negative or as yet not known, the suggestion is for cytotoxic chemotherapy. Cetuximab an monoclonal antibody that binds to EGFR and competitively inhibits ligand binding, was investigated as a first line treatment of patients with high level NSCLC. The First Line Erbitux in Lung Cancer study was conducted as an international randomized double blind phase III clinical trial of 1125 patients with higher level NSCLC with EGFR expressing tumors. Patients were randomized to treatment with chemotherapy alone or chemotherapy plus cetuximab. Even though the OS benefit was marginal in the cetuximab supply and there was no benefit in average PFS, the RR was significantly higher in patients receiving cetuximab plus chemotherapy. From these marginal results in the FLEX study, the justification for cetuximab in first line combination therapy was debateable. Two meta studies evaluated the efficacy and safety of cetuximabbased therapy in the setting of high level metastatic NSCLC. The first meta research examined 4 qualified randomized controlled trials that included 1003 and 1015 patients randomized to CBT and get a handle on treatment, respectively. The CBT arm demonstrated a 3 months reduction in the risk of disease progression, a reduction Gene expression in the risk of death, and an approximately 50% increase in objective RR. The other recent meta analysis, from 10 RCTs involving 5936 people, also demonstrated longer OS and higher RR in cetuximab plus platinum based doublet chemotherapy compared with PBDC alone. Despite these limited benefits, cetuximab is recommended as a category 2B in combination with platinum based chemotherapy in NCCN practice recommendations for advanced/metastatic NSCLC. A retrospective analysis of the FLEX study recommended that EGFR protein expression by immunohistochemical assessment is an inadequate predictor of EGFR specific therapy. Similarly, a analysis of EGFR amplification by FISH did not correlate with reaction to cetuximab in 279 of 1125 patients. Since the most useful predictor of cetuximab treatment outcome but this study identified the clear presence of skin rash during the first order FK228 cycle of treatment. Maintenance therapy is a technique that has been examined extensively recently as a means of improving results in patients with advanced NSCLC. The Sequential Tarceva in Unresectable NSCLC review, a blind randomized phase III trial, evaluated the power of erlotinib as maintenance therapy in patients who have been free of development after 4 cycles of platinum based therapy. Eight hundred ninety seven patients were randomized to erlotinib or placebo until infection progression. PFS was considerably higher among patients treated with erlotinib versus. placebo.