Abstract: Clinical trials of anti-cancer drugs are characterized by long cycles, high risks, large investments, complex efficacy evaluations, and numerous influencing factors. Traditional experimental design is slow in progress and high in cost, which to some extent increases the uncertainty of research. With the guidance of domestic and international policies and the development of clinical trial methodologies, adaptive design has emerged. Flexible adaptive designs can shorten the clinical trial time of anti-cancer drugs, which is conducive to the discovery of truly effective anti-cancer drugs and therapies, thereby increasing the efficiency and success rate of new drug research and development. Starting from the characteristics of clinical trials of anti-cancer drugs, this article reviews the adaptive designs adopted in current clinical trials, summarizes the characteristics and differences of various adaptive design methods by introducing specific research and development cases, and discusses the problems and challenges faced. This work aims to provide methodological references for clinical trials of anti-cancer drugs.