OBJECTIVES: Lung cancer is one of the most common malignant cancers and also the leading cause of cancer mortality in the world. Platinum-based combination with gemcitabine, vinorelbine, pemetrexed or taxane were wild used for lung cancer in Taiwan. It is very difficult to compare the survival rates of third-generation cytotoxic agent and pemetrexed, when used as first-line platinum-based therapy for lung cancers. Because of the small sample sizes and very limited number of head-to-head studies, efficacy results have been inconclusive.

METHODS: We used Taiwan’s entire 2010–2015 National Health Insurance Database (NHID), registry for catastrophic illness patients and cancer registration file to conduct a retrospective cohort study and investigate this issue.

RESULTS: Lung cancer prevalence in Taiwan increased from 0.11% to 0.16%, and the annual incidence density increased from 0.0524% to 0.0540% from 2010 to 2015. The top one anti-neoplastic first-line therapy used for treating lung cancers were platinum-based therapy (from 47.75%-39.91% in year 2011-2015). In lung cancer patients without surgery, pemetrexed was most frequently used in platinum-based combination therapy (22.77%). The overall survival for pemetrexed was significantly higher than for other platinum-based therapy. The Hazard Ratio in docetaxel, paclitaxel, vinorelbine, gemcitabine, etoposide and other chemotherapy agents as compare to pemetrexed were 1.35 (1.26-1.45), 1.34 (1.23-1.47), 1.29 (1.20-1.40), 1.42 (1.32-1.52), 1.84 (1.72-1.96) and 1.51 (1.34-1.71).

CONCLUSIONS: These results indicated that first-line pemetrexed combination shows better overall survival compared with other chemotherapy agents in platinum-based therapy.