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.
Targetable Mutation Driver (EGFR, ALK, ROS1)
For advanced/ stage 4 non small cell lung cancer (NSCLC), specifically adenocarcinoma, those with EGFR and ALK mutations will have longer survival with EGFR and ALK tyrosine kinase inhibitors (TKIs) treatment.
Median/ average overall survival with EGFR-TKIs range between 21.6 months – 30.9 months
Median/ average overall survival with TKIs targeting ALK mutation ranges between 16.7 months – 20.3 months.
What more? Immunotherapy.
Results from immunotherapy trials had been very promising and there is possibility for long term remission.
In many trials, the median/ average survival duration data is not mature yet because many patients are still alive.
For advanced lung cancer, a lot of different treatments had been introduced in recent time, which translate to longer overall survival.
Please do not tell patients that they have just 6 months to live anymore.
In fact, it is one of the cancer with the longest survival now.
Just advice them to seek treatment promptly.
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