From the Guidelines
The prognosis for untreated stage IV lung cancer is extremely poor, with a 5-year survival rate of approximately 2%. The survival time without treatment is generally short, with a median survival time of about 4-6 months 1. Without any therapeutic intervention, patients with metastatic lung cancer face a very low 5-year survival rate. The prognosis varies somewhat depending on the specific type of lung cancer, the patient's overall health status, age, and the extent of metastasis.
Key Factors Influencing Prognosis
- The type of lung cancer (small cell vs. non-small cell)
- The patient's overall health status
- Age
- The extent of metastasis
The disease typically progresses rapidly without treatment, leading to increasing symptoms such as severe shortness of breath, pain, fatigue, weight loss, and eventually respiratory failure. Palliative care becomes essential in these cases to manage symptoms and improve quality of life, even when curative treatment is not pursued.
Importance of Treatment
This poor prognosis underscores why oncologists typically recommend some form of treatment for stage IV lung cancer when possible, as modern therapies including immunotherapy, targeted therapy, and palliative chemotherapy can often extend survival significantly beyond these untreated timeframes and improve quality of life 1. Early initiation of palliative care is suggested to improve both quality of life and duration of survival 1.
Treatment Options
Treatment options may include platinum-based two-drug combination of cytotoxic drugs, non-platinum combination chemotherapy, or targeted therapies such as gefitinib for patients with known epidermal growth factor receptor (EGFR) mutation 1. Second-line systemic treatment with docetaxel, pemetrexed, or erlotinib can also improve disease-related symptoms and survival 1.
Conclusion Not Applicable
Instead, the focus should be on the immediate consideration of treatment options to improve survival and quality of life for patients with stage IV lung cancer.
From the Research
Prognosis for Untreated Stage IV Lung Cancer
The prognosis for untreated stage IV lung cancer is generally poor. According to 2, 25%-30% of patients with stage IV nonsmall cell lung cancer (NSCLC) die within 3 months of diagnosis.
Survival Rates
- The median survival time for patients with stage IV NSCLC is around 10 months, with 1-, 2-, 3-, 4-, and 5-year survival rates of 44%, 22%, 13%, 9%, and 6%, respectively 3.
- For patients who survive more than 3 months, the median survival time is around 16-23 months, with 1-, 2-, and 5-year survival rates of 74%, 49%, and 16%, respectively 2, 4.
- The survival rate can vary depending on the type of lung cancer, with adenocarcinoma having a better prognosis than squamous cell carcinoma 3.
Factors Affecting Prognosis
- The number of metastatic organs and the location of metastases can affect prognosis, with patients having a single metastasis or metastasis to the lung having a better prognosis than those with multiple metastases or metastasis to other organs 3.
- Treatment can also affect prognosis, with patients receiving chemotherapy, radiotherapy, or targeted therapy having a better prognosis than those receiving best supportive care only 2, 3.
- Other factors that can affect prognosis include performance score, TNM substage, and the presence of EGFR mutations 2, 4.
Treatment Options
- Palliative radiotherapy is a common treatment option for stage IV lung cancer, particularly for symptom control 5.
- Immunotherapy, such as pembrolizumab, in combination with platinum-based doublet chemotherapy, has shown promising results in treating stage IV NSCLC, with a median progression-free survival of 11 months and a median overall survival of 23 months 6.