Stage 4 Lung Cancer: How Long Can I Live? (2)

I saw a patient today with stage 4 lung cancer. He told me he has another 4-6 months to live, according to his doctor.

Is it true? NO

Nowadays, it is not just ‘stage 4’ determining the survival time. Let me elaborate. I will try to keep it simple.

First, there is the histology of the lung cancer: small cell lung cancer (SCLC – most aggressive lung cancer) or non small lung cancer (NSCLC; adenocarcinoma, squamous, etc.).

  • For extensive stage SCLC, the median/ average survival time with chemotherapy is about 8.4 months. Sundstrom, JCO, 2002.
  • If the histology is NSCLC with no targetable mutation driver and unsuitable for immunotherapy, chemotherapy still offer median/ average survival time of 10.8 months – 11.8 months.
GV Scagliotti, JCO, 2005

With NSCLC, specifically adenocarcinoma, those with EGFR and ALK mutations will have even longer survival with EGFR and ALK thyrosine kinase inhibitors (TKIs) treatment.

Median/ average overall survival with EGFR-TKIs range between 21.6 months – 30.9 months

List of 1st and 2nd generation EGFR-TKIs

Median/ average overall survival with TKIs targeting ALK mutation ranges between 16.7 months – 20.3 months.

List of ALK-TKI trials
List of ALK-TKI trials

What more? Immunotherapy. Results from immunotherapy trials had been very promising and there is possibility for long term remission. The median/ average survival duration data is not mature yet because many patients are still alive.

Finally

In conclusion, advanced lung cancer had been seeing huge improvement in treatment, which translate to longer overall survival. Please do not tell patients that they have just 6 months to live anymore. Just advice them to seek treatment promptly.

UPDATE (8/6/2018)

JCO, Mok 2018

  • ARCHER 1050, a randomized, open-label, phase III study
  • Dacomitinib (irreversible pan-HER inhibitor) versus gefitinib in first line treatment
  • Patients with advanced non–small-cell lung cancer (NSCLC) and EGFR mutation positive
  • Improvement in progression free survival – 14.7 months with dacomitinib versus 9.2 months with gefitinib
  • Average/ median overall survival was 34.1 months with dacomitinib versus 26.8 months with gefitinib
    • At 2.5 years, 56.2% and 46.3% with dacomitinib and gefitinib, respectively are still alive

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