What is the success rate of chemotherapy for lung cancer

ON THIS PAGE: You will find information about the number of people who are diagnosed with non-small cell lung cancer (NSCLC) each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

Worldwide, lung cancer is the second most commonly diagnosed cancer. NSCLC is the most common type of lung cancer in the United States, accounting for 82% of all lung cancer diagnoses.

This year, an estimated 236,740 adults (117,910 men and 118,830 women) in the United States will be diagnosed with lung cancer. Worldwide, an estimated 2,206,771 people were diagnosed with lung cancer in 2020. These statistics include both small cell lung cancer and NSCLC.

In the United States, the number of new lung cancer cases in men has been dropping annually since the mid-1980s. In women, the number of new cases diagnosed each year started dropping in the mid-2000s. Between 2009 and 2018, incidence rates dropped 1.4% each year in women compared to 2.8% each year in men.

Currently, Black and White women have lower incidence rates than men. Black men are about 15% more likely to get lung cancer than White men. Black women are 16% less likely to get lung cancer when compared with White women. People age 65 and older are more likely to develop the disease. The average age of diagnosis is 70.

Lung cancer is the leading cause of cancer death for men and women worldwide. It is estimated that 130,180 deaths (68,820 men and 61,360 women) from this disease will occur in the United States this year. In 2020, an estimated 1,796,144 people died worldwide from the disease.

Lung cancer makes up around 25% of cancer deaths in the United States. However, death rates for the disease have declined by 56% since 1990 in men and 32% since 2002 in women. From 2015 to 2019, the death rates for men with lung cancer dropped by around 5% each year. The death rates for women with lung cancer declined 4% per year. Research indicates that these declines are due to more people not smoking, more people quitting smoking, and advances in diagnosis and treatment.

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for all people with all types of lung cancer is 22%. The 5-year survival rate for men is 18%. The 5-year survival rate for women is 25%. The 5-year survival rate for NSCLC is 26%, compared to 7% for small cell lung cancer.

However, it is important to note that survival rates depend on several factors, including the subtype of lung cancer and the stage of disease.

For people with localized NSCLC, which means the cancer has not spread outside the lung, the overall 5-year survival rate is 63%. For regional NSCLC, which means the cancer has spread outside of the lung to nearby lymph nodes, the 5-year survival rate is about 35%. When cancer has spread to distant parts of the body, called metastatic lung cancer, the 5-year survival rate is 7%. It is important to note that newer therapies like targeted treatments and immunotherapies (see Types of Treatment) are allowing people with metastatic lung cancer to live longer than ever before.

Each year, tens of thousands of people are cured of NSCLC in the United States. And, some patients with advanced lung cancer can live many years after diagnosis. Sometimes patients who are told that their lung cancer is incurable live longer than many who are told that their lung cancer is curable. The important thing to remember is that lung cancer is treatable at any stage, and these treatments have been proven to help people with lung cancer live longer with better quality of life.

It is important to remember that statistics on the survival rates for people with NSCLC are an estimate. The estimate comes from annual data based on the number of people with this cancer in the United States. Also, experts measure the survival statistics every 5 years. This means the estimate may not reflect the results of advancements in how NSCLC is diagnosed or treated from the last 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2022, the ACS website, and the International Agency for Research on Cancer website. (All sources accessed January 2022.)

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by NSCLC. Use the menu to choose a different section to read in this guide.

Content Contributor: The Abramson Cancer Center of the University of Pennsylvania

Last Reviewed: June 24, 2013

Lung cancer is one of the most common cancers, and is the leading cause of cancer death in the U.S. and internationally. Worldwide, there are an estimated 1.61 million new cases (estimated 228,190 in the U.S. in 2013) and over 1.38 million deaths (estimated 159,480 in the U.S. in 2013) each year. This is compared to 600,000 cases diagnosed in 1975, and the increase is directly related to tobacco use.
Research into screening tests is aimed at identifying patients with earlier stage disease. Yet, even when diagnosed early, the percentage of patients alive in five years ranges from only 30-60%. The five-year survival rate for all stages combined is a mere 15%. Lung cancer is further divided into two categories, small cell lung cancer and non-small cell lung cancer, which are treated differently. Non-small cell lung cancer makes up about 87% of cases, and is the type which we will discuss in this article.

When possible, early stage lung cancer is treated with surgery to resect the tumor. (See staging of lung cancer ) When a recurrence occurs, it is 2-3 times more likely to be somewhere else in the body, as opposed to the lung. This brings up the question: would chemotherapy after surgery (also called adjuvant chemotherapy) have killed those cancer cells that were able to survive the surgery and later reappear somewhere else in the body? This question has puzzled doctors for some time. Chemotherapy is not without side effects, and one would not want to undergo chemotherapy unless one could achieve some gain in survival. There are several studies which have looked at this question in early stage disease, so let's review them.
Early studies did not have large numbers of participants, which makes it difficult to interpret those results. Researchers can combine the results of multiple studies to get a bigger perspective; this is called a meta-analysis. In 1995, researchers performed a meta-analysis of all the studies of early-stage non-small cell lung cancer from 1965 to 1991. They found that chemotherapy with radiation actually reduced survival in these studies, but the types of chemotherapy drugs used varied widely, making it difficult to apply this finding to the current chemotherapies. They did find that chemotherapy regimens using cisplatin, even without radiation, increased the five-year survival by 5%. This number was not "statistically significant", meaning that this increase could have been just luck. A statistically significant result is one that is more than likely true, and not likely to happen by chance. Doctors use statistical significance as a measure of a therapy's success. Although the 5% difference was not statistically significant, it raised interest in doing further studies with early stage patients.

The next study was called Adjuvant Lung Project Italy (ALPI), and included 1,088 patients with stage I, II & IIIA disease. It showed no benefit in survival by adding cisplatin-based chemotherapy (meaning a regimen of medications that includes cisplatin and usually not more than 3 chemo drugs). One year later, results from the International Adjuvant Lung Cancer Trial (IALT) were released. The study included 1,867 patients, stages I, II & IIIA, who were treated with cisplatin-based chemotherapy. Results showed a 4% improvement in overall survival at five years. The overall survival represents the number of patients who were alive at five years, but some of these patients may have had active lung cancer. (In contrast, disease-free survival only counts those patients who were alive AND free of disease at that time point.) This 4% improvement includes all studied stages of disease, so the number could be less impressive if you were only looking at stage IB disease, but that was not done in this study. The next three studies did break down the results by stage, helping to answer some of the questions raised by IALT.

A trial conducted by The National Cancer Institute of Canada Clinical Trials Group (NCIC-CTG) included 482 generally healthy patients with stage IB or II surgically resectable lung tumors. Patients were assigned to receive either chemotherapy with cisplatin and vinorelbine or observation. The five-year overall survival was 15% higher in the chemotherapy group (69% survival with chemo vs. 54% survival with observation). These numbers include stage IB and II disease. When researchers separated out stage IB, they found no "statistically significant" benefit for the chemotherapy group with stage IB.
The next study, run by the Cancer and Leukemia Group B (CALGB), included 344 patients with stage IB resectable disease. Patients were assigned to receive either chemotherapy with paclitaxel and carboplatin or observation. This study was first reported in 2004, with a follow up of 34 months. The study had been stopped early because an analysis showed a statistically significant benefit in the chemotherapy arm. The four-year overall survival was 12% higher in the chemotherapy group (71% survival with chemo vs. 59% survival with observation) at the time of the original report. The group also saw improvement in the mortality caused by lung cancer, with 19 deaths in the chemotherapy group and 34 deaths in the observation group attributed to lung cancer. There were no deaths related to chemotherapy toxicity, and neutropenia was the most common toxicity.

At the 2006 national meeting (ASCO), the anxiously awaited updated results of this study were presented. This report had a follow up of 54 months, and at that point, the overall survival between the two groups was no longer statistically significant [63% in chemotherapy arm vs. 57.3% in the observation arm (p=0.10)]. At first glance, it would seem that chemotherapy is of no advantage to stage IB patients, but there is more to be considered. Given that this trial was closed early, the number of patients is smaller, and it is hard to tell if a larger sample size would have shown more benefit. The investigators plan to update this trial as time goes on, but this leaves current patients and oncologists with a difficult decision. Of note, the investigators found through an unplanned subset analysis that patients with tumors greater than 4cm in size derived more benefit from chemotherapy. One must be very cautious in making decisions on subset analyses because the trial was not actually designed to answer this question. Subset analyses should be considered hypothesis generating and not definitive. Thus this should be considered a negative study for the use of chemotherapy in patients with IB NSCLC.
The last study, called The Adjuvant Navelbine International Trialist Association (ANITA), assigned 840 patients with resected IB, II, or IIIA disease to receive either chemotherapy with vinorelbine and cisplatin or observation. This study found improved overall survival in the chemotherapy group, with 51% survival with chemo vs. 43% survival with observation. This study, like the NCIC-CTG study, did not find a statistically significant benefit for stage IB patients. All three of these studies reported that the chemotherapy regimens were well tolerated by patients, with acceptable side effect profiles.
Based on the previous three trials, oncologists must discuss the pros and cons of adjuvant chemotherapy with each patient on an individual basis. What does remain clear is that patients with Stage IA disease do not seem to derive any benefit from adjuvant treatment with currently available chemotherapy regimens. Although some will argue in favor of chemotherapy for certain subsets of IB NSCLC, there is no definitive prospective evidence that patients derive benefit from chemotherapy. Ultimately, patients must discuss the pros and cons of their individual situation with their oncologist.

References

American Cancer Society, Facts and Figures, 2006. www.cancer.org

Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. Non-small Cell Lung Cancer Collaborative Group. British Medical Journal 1995;311:899-909.

Arriagada R, Bergman B, Dunant A, Le Chevalier T, Pignon JP, Vansteenkiste J. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. New England Journal of Medicine 2004;350:351-60.

Douillard J-Y, Rosell R, Delena M, et al. ANITA: Phase III adjuvant vinorelbine and cisplatin versus observation in completely resected (stage I-III) non-small cell lung cancer patients: final results after 70-month median follow-up. Journal of Clinical Oncology 2005;23: Suppl 16S:624s. abstract.

Pisters KM. Adjuvant chemotherapy for non-small-cell lung cancer--the smoke clears. New England Journal of Medicine 2005;352:2640-2.

Scagliotti GV, Fossati R, Torri V et al. Randomized study of adjuvant chemotherapy for completely resected stage I, II, or IIIA non-small-cell Lung cancer. Journal of the National Cancer Institute 2003;95:1453-61.

G. M. Strauss, et al. Adjuvant paclitaxel plus carboplatin compared with observation in stage IB non-small-cell lung cancer: CALGB 9633 with the Cancer and Leukemia Group B, Radiation Therapy Oncology Group, and North Central Cancer Treatment Group Study Groups. Journal of Clinical Oncology 2008, 26(31):5043-5051.

Strauss GM, Herndon J, Maddaus MA, et al. Randomized clinical trial of adjuvant chemotherapy with paclitaxel and carboplatin following resection in stage IB non-small cell lung cancer (NSCLC): report of Cancer and Leukemia Group B (CALGB) protocol 9633. Journal of Clinical Oncology 2004;22:Suppl 14S:621s. abstract.

Winton T, Livingston R, Johnson D et al. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. New England Journal of Medicine 2005;352:2589-97.

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