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Background  Platinum‐based chemotherapy is the standard first‐line treatment for patients with advanced pan‐negative non‐squamous (non‐Sq) non‐small cell lung cancer (NSCLC). However, it is unknown which chemotherapy regimen confers the greatest benefit in such patients. This study explored which chemotherapy regimens were advantageous in non‐Sq NSCLC patients.    Methods  A retrospective study was conducted on 114 patients with advanced non‐Sq NSCLC using platinum‐based chemotherapy in a first‐line setting between January 2013 and December 2015. The study evaluated the most common first‐line regimens including pemetrexed/platinum (PP), paclitaxel/carboplatin, gemcitabine/platinum, and vinorelbine/cisplatin. The primary endpoint was progression‐free survival (PFS), and secondary endpoints were the objective response rate and disease control rate (DCR). Univariate and multivariate logistic analysis was carried out.    Results  Sixty of the 114 patients were administered PP regimens and 54 non‐pemetrexed plus platinum (NPP) regimens. The median PFS was significantly longer in the PP than in the NPP group (7.2 months, 95% confidence interval [CI] 5.3–9.1 vs. 4.9 months, 95% CI 3.2–6.6;  P  = 0.031). The DCR of the PP regimen was better than that of the NPP regimen (90.0% vs. 74.1%;  P  = 0.026). Smoking status was an independent predictor of PFS (hazard ratio 2.1, 95% CI 1.4–3.3;  P  = 0.001) in a final multivariate Cox regression model.    Conclusions  A PP regimen tends to be more beneficial than an NPP regimen for patients with pan‐negative advanced non‐Sq NSCLC. Smoking status may be a valuable predictor for the selection of a chemotherapy regimen in such patients.

Comparing first‐line treatment patterns and clinical outcomes of patients with pan‐negative advanced non‐squamous non‐small cell lung cancer