From the Guidelines
The prognosis for Stage IV lung cancer remains poor, but recent advancements in treatment options have improved life expectancy and quality of life, with a focus on managing symptoms and slowing disease progression 1.
Overview of Stage IV Lung Cancer
The treatment of advanced stage IV non–small cell lung cancer (NSCLC) has evolved dramatically in the past decade, with living practice guidelines for systemic management being updated recently to reflect this rapidly evolving treatment landscape 1.
Treatment Approaches
Treatment typically involves a combination of approaches including:
- Systemic therapy (chemotherapy, immunotherapy, or targeted therapy)
- Radiation therapy
- Supportive care For non-small cell lung cancer (NSCLC), which accounts for about 85% of lung cancers, first-line treatment often includes platinum-based chemotherapy regimens such as carboplatin/paclitaxel or cisplatin/pemetrexed, sometimes combined with immunotherapy drugs like pembrolizumab (Keytruda) 1.
Targeted Therapies
For patients with specific genetic mutations, targeted therapies like osimertinib (Tagrisso) for EGFR mutations or alectinib (Alecensa) for ALK rearrangements may significantly improve outcomes 1.
Palliative Care
For patients with stage IV lung cancer and/or a high symptom burden, it is suggested that palliative care combined with standard oncology care be introduced early in the treatment course 1.
Key Considerations
The exact treatment plan depends on the specific cancer subtype, genetic profile, overall health status, and patient preferences. While stage IV lung cancer remains incurable for most patients, these treatments can help manage symptoms, slow disease progression, and in some cases, lead to longer-term survival, particularly for those with targetable genetic mutations who respond well to specific therapies. The most recent guideline recommends a personalized approach to treatment, taking into account the latest advancements in therapy for stage IV NSCLC without driver alterations 1.
From the FDA Drug Label
The median OS was 12.3 months vs. 10.3 months [HR 0.80 (95% CI: 0.68,0. 94), final p-value of 0. 013, stratified log-rank test]. Of the 89% with newly diagnosed NSCLC, 12% had Stage IIIB with malignant pleural effusion and 76% had Stage IV disease. The OS results are presented in Table 58 and Figure 8. Table 58: Efficacy Results (PD-L1 ≥1%) - CHECKMATE-227 Part 1a OPDIVO and Ipilimumab(n=396) Platinum-Doublet Chemotherapy(n=397) Overall Survival Events (%) 258 (65%) 298 (75%) Median (months)a (95% CI) 17.1 (15,20.1) 14.9 (12.7,16.7) Hazard ratio (95% CI)b 0. 79 (0.67,0.94)
The prognosis for Stage IV lung cancer is generally poor, with a median overall survival (OS) of 12.3 months in one study 2 and 17.1 months in another study 3 for patients receiving certain treatments. The hazard ratio for OS was 0.80 (95% CI: 0.68,0.94) in one study 2 and 0.79 (95% CI: 0.67,0.94) in another study 3, indicating a statistically significant improvement in OS for patients receiving the treatments. However, it's essential to note that these results are based on specific treatment regimens and patient populations, and the prognosis may vary depending on individual factors.
From the Research
Prognosis for Stage IV Lung Cancer
The prognosis for Stage IV lung cancer varies depending on several factors, including the type of lung cancer, the patient's overall health, and the treatment approach.
- According to a study published in 2023 4, the median progression-free survival for patients with Stage IV non-small cell lung cancer treated with pembrolizumab in combination with platinum-based doublet chemotherapy was 11.0 months, and the median overall survival was 23.1 months.
- A study published in 2006 5 found that the addition of bevacizumab to paclitaxel plus carboplatin in the treatment of selected patients with non-small-cell lung cancer resulted in a significant survival benefit, with a median survival of 12.3 months compared to 10.3 months with chemotherapy alone.
- Another study published in 2010 6 reported that the combination of carboplatin, pemetrexed, and bevacizumab in patients with advanced non-small-cell lung cancer resulted in a response rate of 52% and a median overall survival of 83% at 12 months.
- A study published in 2020 7 explored the value of immunotherapy for survivors of Stage IV non-small cell lung cancer and found that long-term survivors experienced a limbo state, where they were able to achieve some semblance of normalcy despite having a terminal condition.
- A case report published in 2022 8 highlighted the potential association between PTEN mutation and resistance to anti-PD-1 immunotherapy in lung adenocarcinoma, suggesting that PTEN mutation may serve as a biomarker of resistance to immunotherapy.
Treatment Outcomes
Treatment outcomes for Stage IV lung cancer can vary significantly depending on the treatment approach and individual patient factors.
- The study published in 2023 4 reported a survival rate of 82.3% and 43.3% after 1 and 2 years, respectively, for patients treated with pembrolizumab in combination with platinum-based doublet chemotherapy.
- The 2006 study 5 found that the addition of bevacizumab to chemotherapy resulted in a significant improvement in overall survival, with a hazard ratio for death of 0.79.
- The 2010 study 6 reported that the combination of carboplatin, pemetrexed, and bevacizumab resulted in a median progression-free survival of 6.2 months and a median overall survival of 12.3 months.
Quality of Life
The quality of life for patients with Stage IV lung cancer can be significantly impacted by their treatment and disease progression.
- The 2020 study 7 found that long-term survivors of Stage IV non-small cell lung cancer experienced a limbo state, where they were able to achieve some semblance of normalcy despite having a terminal condition, and that this limbo state impacted their life priorities, decision-making, and experience of patient support.
- The study suggested that increased awareness of the specific experiences of long-term survivors on immunotherapy may direct how resources should be spent for cancer support for patients and their families.