Abstract: Objective To evaluate the clinical efficacy, toxicity and prognostic factors of docetaxel or pemetrexed alone as the fi rst-line treatment for elderly patients with advanced lung adenocarcinoma. Methods Retrospective analysis was adopted to evaluate 89 elderly patients with advanced lung adenocarcinoma(≥65 years) who were hospitalized in the Department of Oncology, Guangzhou General Hospital of Guangzhou Military Command, from September 2008 to March 2012. Among them, 42 patients were treated with docetaxel (75 mg/m2, iv, d1) and 47 patients were treated with pemetrexed (500 mg/m2, iv d1). Three weeks were considered as one session for both of treatments and each of them should be repeated at least twice. Results The response rate(RR), disease control rate (DCR), time to progress(TTP), median survival time(MST) and 1 year survival rate of docetaxel and pemetrexed treatments were 19.0% and 25.5%, 61.9% and 63.8%, 3.0 months and 3.6 months, 8.5 months and 9 months, 31.0% and 38.3%, respectively. There was no signifi cant difference in RR, DCR, TTP, and MST as well as one year survival rate between two treatments (P>0.05). Notably, the side effects including anemia, leukocytopenia,nausea,vomiting,diarrhea,psilosis and fatigue in the pemetrexed group were significantly lower than those in the docetaxel group (P<0.05). Moreover, Cox multivariate regression analysis showed that TTP, ECOG,neoplasm staging and RR were independent factors for the survival rate (P<0.05). On the other hand, the factors such as gender, age and smoking status were not related to the prognosis of survival rate of patients(P>0.05). Conclusion The effi cacy was identical between docetaxel and the pemetrexed regimen, but toxicity of latter was much lower than that of the former.