Research and standard of care: lung cancer in romania.

In Romania, lung cancer is the most frequent cancer in men and fourth most frequent in women, and its incidence and mortality continue to rise. Recently, firm antitobacco policies were implemented, in agreement with the MPOWER strategies recommended by the World Health Organization (WHO). As of January 2012, the recognized "official" standard of care in lung cancer is still represented by the 2009 edition of the European Society for Medical Oncology (ESMO) guidelines. Cancer treatment is free, as the National Program of Oncology covers the budget for all cytotoxic agents and targeted therapy. However, reimbursement for several expensive drugs such as pemetrexed, erlotinib, and bevacizumab is individually approved by a centralized commission. All new drugs registered in Europe by the European Medicines Agency are concomitantly registered in Romania. However, no new drugs (such as gefitinib) or new indications (such as first-line tyrosine-kinase inhibitors or maintenance treatment) have been accepted for reimbursement since 2008. Clinical research is rapidly growing, and Romanian centers demonstrate a high recruitment rate in pivotal trials, despite initial delays because of a slow approval of the studies by authorities.