Objective To evaluate the efficacy and toxicity of pemetrexed(PEM) or taxol (TAL) plus carboplatin chemotherapy as first-line treatment for elderly advanced lung adenocarcinoma. Methods One hundred and nine patients (≥65 years) with advanced lung adenocarcinoma were treated with pemetrexed plus carboplatin (PC) or taxol plus carboplatin (TC) regimen as first-line chemotherapy. Fifty-three patients received PC regimen: pemetrexed 500 mg/m², intravenous drip day 1; Fifty-six patients received TC regimen: taxol 135-175 mg/m², intravenous drip day 1; carboplatin in both groups: area under the curve 4-5 mg/(ml·min), day 2; every 3 weeks. Each patient was evaluated on efficacy and toxicity after at least 2 cycles. The general characteristics of patients in the two groups were comparable. Results The response rates in PC group and TC group were 33.9% and 26.8%, whereas the disease control rates were 75.4% and 69.7%, respectively; there was no significant difference between the two groups. Median progression-free survival was 6.5 months in the PC group, and 4.7 months in the TC group, there was also no significant difference. The median overall survival rate in PC group was significantly higher than that in TC group with 16.8 months and 11.8 months, respectively; the difference was statistically significant (P=0.032).The 2-year and 3-year survival rates in the two groups were 27.3% and 24.3%, 14.2% and 12.5%, respectively; no significant difference was found between the two groups. The main toxicity was myelosuppression. Leucocytopenia, neutropenia and alopecia were more common in the TC group. Conclusions Both the PC regimen and TC regimen are moderately safe and effective for elderly advanced lung adenocarcinoma as first-line treatment. The PC regimen has higher survival rate and tolerated toxicity. It is worth further clinical study.