From the Guidelines
Stage 4 lung cancer has a generally poor prognosis, with a 5-year survival rate of about 1% to 2%, as indicated by the most recent evidence 1. This advanced stage means the cancer has spread from the lungs to distant organs like the brain, bones, liver, or adrenal glands. The median survival time typically ranges from 8 to 12 months with treatment. However, prognosis varies significantly based on several factors including:
- the specific type of lung cancer (small cell vs. non-small cell)
- the patient's overall health and performance status
- age
- presence of specific genetic mutations that may respond to targeted therapies
- how extensively the cancer has spread Treatment options usually focus on extending life and improving quality of life rather than cure, and may include:
- chemotherapy regimens (such as carboplatin/pemetrexed, cisplatin/etoposide)
- targeted therapies (like osimertinib for EGFR mutations or alectinib for ALK mutations)
- immunotherapy (pembrolizumab, nivolumab)
- radiation therapy
- palliative care Some patients with specific genetic mutations who receive targeted therapies may survive significantly longer than the average, as supported by studies such as 1. It's essential for patients to discuss their individual situation with their oncologist to understand their specific prognosis and treatment options, considering the latest guidelines and recommendations 1.
From the Research
Stage 4 Lung Cancer Prognosis
- The prognosis for stage 4 lung cancer patients can vary depending on several factors, including the type of lung cancer, the patient's overall health, and the effectiveness of treatment 2, 3.
- Studies have shown that immunotherapy, particularly with PD-1/PD-L1 inhibitors, can improve survival rates for patients with advanced lung cancer, including those with stage 4 disease 3, 4, 5.
- A network meta-analysis found that platinum-based chemotherapy plus pembrolizumab or nivolumab and ipilimumab was associated with the best survival rates for patients with <1% PD-L1 expression, while platinum-based chemotherapy plus pembrolizumab produced better survival than chemotherapy in patients with 1-49% PD-L1 expression 2.
- Another study found that pembrolizumab was associated with significantly longer progression-free and overall survival, and with fewer adverse events, than platinum-based chemotherapy in patients with advanced NSCLC and PD-L1 expression on at least 50% of tumor cells 3.
- The combination of PD-1/PD-L1 inhibitors with chemotherapy has emerged as a promising therapeutic option for advanced non-small-cell lung cancer (NSCLC), with improved progression-free survival, overall survival, and overall response rate compared to chemotherapy alone 4, 5.
Treatment Options
- Immunotherapy with PD-1/PD-L1 inhibitors, such as pembrolizumab, nivolumab, and atezolizumab, has shown promise in improving survival rates for patients with stage 4 lung cancer 2, 3, 4, 5.
- Chemotherapy, including platinum-based chemotherapy, is also a common treatment option for stage 4 lung cancer, and may be used in combination with immunotherapy 2, 3, 4, 5.
- The choice of treatment will depend on the individual patient's circumstances, including the type and stage of their cancer, their overall health, and their personal preferences 2, 3, 4, 5.
Survival Rates
- The survival rates for stage 4 lung cancer patients can vary depending on several factors, including the type of lung cancer, the patient's overall health, and the effectiveness of treatment 2, 3, 4, 5.
- Studies have reported improved survival rates for patients with stage 4 lung cancer who receive immunotherapy with PD-1/PD-L1 inhibitors, either alone or in combination with chemotherapy 3, 4, 5.
- For example, one study found that the estimated rate of overall survival at 6 months was 80.2% in the pembrolizumab group versus 72.4% in the chemotherapy group 3.