This real-world, retrospective cohort study provides valuable clinical evidence supporting the efficacy and manageable safety of first-line double-dose icotinib (750 mg/day) in patients with advanced EGFR-mutant lung adenocarcinoma, particularly enriching the existing literature by focusing on a challenging population characterized by advanced age, poor performance status (ECOG PS 2 predominance), and high metastatic burden. The gene discussed is EGFR; the disease is lung adenocarcinoma.