Objective: To present a systematic review of the usage of antitumor drugs in Chinese hospitals from 2009 to 2011. Methods: The market data of antitumor drugs was collected from the Menet database that covered 350 Class A tertiary hospitals from 16 major cities in China. The data of antitumor drugs were divided into 3 categories by mechanism action: cytotoxic chemotherapy, molecular targeted therapeutic drugs, and other antitumor drugs. The usage characteristics of each category were analyzed through sales volume and sales value, and the characteristics of main drugs in each category were further analyzed. Results: During 2009-2011, the sales volume and sales value of antitumor drugs used in hospitals had markedly increased in China. Specifically, cytotoxic chemotherapy was the most prevalent category in clinical treatment, with total sales volume shares of 61.93%, 63.90%, and 68.40% during 2009-2011. Its share of total sales value was more than 70% in the same period. The sales volume share of molecular targeted therapeutic drugs was less than 1%, but the sales value share was about 20% in the corresponding period. In addition, plant alkaloids had become the leading subcategory of antitumor drugs in hospitals, which contributed 43.72% of total sales volume and 37% of total sales value in 2011. Antimetabolites still played an important role, with around 20% of sales volume, and monoclonal antibody and small-molecule compounds experienced rapid growth. Conclusions: Plant alkaloids have become the most widely used antitumor drug for clinical medical treatment in China. In the future, monoclonal antibody and small-molecule compounds are expected to have wider usage in China. © The Author(s) 2014.