What are the survival rates for cancer patients with and without chemotherapy?

Survival Data for Cancer Patients With and Without Chemotherapy

The survival benefit of chemotherapy varies dramatically by cancer type and stage, with the most compelling data showing chemotherapy improves overall survival by 3-8 months in advanced gastric cancer (8 vs. 5 months), extends median survival from 72.5 to 123 days in second-line gastric cancer, and provides absolute survival improvements of 3-13% at 5 years depending on cancer stage and type. 1

Advanced/Metastatic Disease Survival Data

Gastric Cancer

• Chemotherapy versus best supportive care alone: Overall survival was 8 months with chemotherapy compared to 5 months with best supportive care alone, though this difference was not statistically significant 1
• Time to progression: 5 months with chemotherapy versus 2 months with best supportive care 1
• Quality of life benefit: 45% of patients receiving chemotherapy had improved or prolonged high quality of life for minimum 4 months, compared to only 20% receiving best supportive care alone 1
• Second-line therapy: Irinotecan significantly prolonged overall survival to 123 days compared to 72.5 days with best supportive care only 1

Metastatic Breast Cancer

• 5-year survival rates: For metastatic breast cancer, 5-year survival is approximately 26% with treatment for distant metastases in breast cancer and 10% for colorectal cancer 1
• Hormone receptor-positive metastatic breast cancer: Expected 5-year survival rates of 28-29% for luminal subtypes (ER and/or PR positive, HER2-negative) 2
• Triple-negative metastatic breast cancer: Only 7% 5-year survival with median survival of 13-17 months without optimal therapy 2

Non-Small Cell Lung Cancer (NSCLC)

• Median survival with chemotherapy: 9.3-10.0 months with paclitaxel plus cisplatin versus 7.4 months with cisplatin plus etoposide 3
• 1-year survival rates: 36-40% with paclitaxel-based regimens versus 32% with cisplatin/etoposide 3
• Time to progression: 4.2-4.9 months with paclitaxel combinations versus 2.7 months with control 3

Early-Stage Disease Survival Data

Adjuvant Breast Cancer

• Disease-free survival benefit: Patients receiving AC followed by paclitaxel had 22% reduction in risk of disease recurrence (HR=0.78,95% CI 0.67-0.91, p=0.0022) 3
• Overall survival benefit: 26% reduction in risk of death (HR=0.74,95% CI 0.60-0.92, p=0.0065) 3
• 5-year outcomes with TAC versus FAC: Disease-free survival 75% versus 68% (HR 0.72, p=0.001); overall survival 87% versus 81% (HR 0.70, p=0.008) 1
• TC versus AC regimen: Overall disease-free survival 85% versus 79% (p=0.018); overall survival 88% versus 84% (p=0.045) 1

Adjuvant NSCLC (Stages I-IIIA)

Absolute survival improvements at 5 years based on stage: 1

• Stage IB: Increases 5-year survival from 64% to 67% (3% absolute benefit)
• Stage II: Increases 5-year survival from 39% to 49% (10% absolute benefit)
• Stage III: Increases 5-year survival from 26% to 39% (13% absolute benefit)

Stage II Colon Cancer

• Controversial benefit: Most trials show no statistically significant survival benefit for adjuvant chemotherapy in average-risk stage II disease 1
• SEER Medicare analysis: No 5-year survival benefit for adjuvant chemotherapy over observation in patients >65 years, even with poor prognostic features (HR 1.03,95% CI 0.94-1.13) 1
• QUASAR trial exception: Small but statistically significant benefit with relative risk of recurrence at 2 years of 0.71 (95% CI 0.54-0.92, p=0.01) 1

Stage III Colon Cancer

• Clear benefit established: Meta-analysis of pooled data from 7 randomized trials showed statistically significant overall survival improvement with 5-FU-based adjuvant therapy in stage III disease but not in stage II 1

Critical Prognostic Factors Affecting Survival

Favorable Factors

• De novo metastatic presentation (versus recurrent disease) 2
• Single metastatic site 2
• Disease-free interval >12 months 2
• Good performance status 2
• Limited number of metastatic sites 2

Unfavorable Factors

• Visceral metastases 2
• Multiple metastatic sites 2
• Short disease-free interval 2
• Recurrence after modern adjuvant therapy 2

Receptor Status and Chemotherapy Benefit

Breast Cancer Subgroup Analysis

• ER-negative tumors: 22.8% more patients survived disease-free at 5 years with chemotherapy 1
• ER-positive tumors: Only 7% benefit from chemotherapy 1
• Paclitaxel benefit by receptor status: Clearly established in receptor-negative subgroup (HR 0.68,95% CI 0.55-0.85), but benefit in receptor-positive patients not yet clear (HR 0.92,95% CI 0.73-1.16) 3

Performance Status Considerations

Patients with poor performance status should receive best supportive care only: 1

• Karnofsky Performance Status (KPS) ≤60
• Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥3

Patients with better performance status (KPS ≥60 or ECOG PS ≤2) may be offered chemotherapy with or without best supportive care 1

Quality of Life Considerations

• Many patients would not choose chemotherapy for a 3-month survival benefit alone but would accept it if it substantially reduced symptoms 4
• The median survival threshold for accepting chemotherapy was 4.5 months for mild toxicity and 9 months for severe toxicity 4
• When chemotherapy provided symptom palliation without prolonging life, 68% of patients chose chemotherapy 4