“Can I be cured if I have lung cancer? How long can I live?”
This is the first question that comes to the mind of almost every lung cancer patient and family, and it is also the question that every oncologist is asked. The short answer is: early-stage lung cancer can be cured with reasonable treatment; even in advanced lung cancer, new targeted and immune therapies offer hope for long-term survival to some patients.
Can lung cancer be cured?
Yes!
Yes! Early-stage lung cancer can be cured. Yes!
The 5-year survival rate for patients with early-stage lung cancer can be 60% to 90% after surgical resection. The 5-year survival rate for late-stage lung cancer is only about 5%. This shows that “early detection, early diagnosis, and early treatment” are essential to cure lung cancer.
Unfortunately, because there are no obvious symptoms in the early stage of lung cancer and we are not aware of early screening, the early diagnosis rate of lung cancer is very low, and about 80% of patients are already in advanced stage when they are diagnosed.
Low-dose computed tomography (LDCT) is recognized as the best means to screen lung cancer in professional circles. It can basically achieve the image quality of ordinary CT while reducing the amount of radiation. Studies both nationally and internationally have demonstrated that LDCT screening can detect approximately 85% to 90% of early-stage (stage I) lung cancers.
How long can I live with lung cancer? What are the factors that affect lung cancer survival?
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1. Type of pathology
Lung cancer can be divided into non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), with the former including several types such as adenocarcinoma, squamous carcinoma, and large cell carcinoma.
Small cell lung cancer is highly malignant and has a poor outcome. The average survival of patients with limited stage small cell cancer is 12 to 18 months, and only 6 to 10 months for extensive stage. Non-small cell cancers account for about 85% of lung cancers, and before the advent of targeted therapy and immunotherapy, the median survival time for patients who could only receive chemotherapy was only 8 to 10 months. However, with these two “new weapons,” the survival of patients with non-small cell cancer has increased significantly.
2. Diagnostic staging
According to global data from the International Association for the Study of Lung Cancer, the 5-year survival rate for lung cancer is closely related to the diagnostic stage. The 5-year survival rate for patients with the earliest stage (stage IA) lung cancer can be 92%, while the most advanced stage (stage IVB) is almost 0. Overall, the earlier the stage, the longer the survival time, and vice versa (table below).
| Staging | Events/Cases | Median survival (months) | 2 year survival rate | 5-year survival |
| IA1 | 68/781 | NR | 97% | 92% |
| IA2 | 505/3105 | NR | 94% | 83% |
| IA3 | 546/2417 | NR | 90% | 77% |
| IB | 560/1928 | NR | 87% | 68% |
| IIA | 215/585 | NR | 79% | 60% |
| IIB | 605/1453 | 66.0 | 72% | 53% |
| IIIA | 2052/3200 | 29.3 | 55% | 36% |
| IIIB | 1551/2140 | 19.0 | 44% | 26% |
| IIIC | 831/986 | 12.6 | 24% | 13% |
| IVA | 336/484 | 11.5 | 23% | 10% |
| IVB | 328/398 | 6.0 | 10% | 0% |
3. Molecular type (mutation status)
Different molecular types correspond to different therapies and imply different efficacy. And drugs are being updated to improve efficacy and extend the life of patients.
Current research is progressing faster with targeted therapies – inhibitor classes of drugs that target EGFR gene mutations, ALK/ROS-1 gene fusions.
The progression-free survival (PFS) of patients with the first-generation EGFR-targeted drugs gefitinib (trade names such as Eressa), erlotinib (trade names such as Troche), and erlotinib (trade names such as Kemena) is about 8 to 13 months.
The latest study showed that patients with non-small cell carcinoma with EGFR mutations who were initially treated with the third-generation EGFR-targeting drug osimertinib (trade name e.g. Theresa) had a progression-free survival of 18.9 months. Osimertinib has been launched in China.
In May 2018, the ALEX study showed that ALK fusion gene-positive patients with the second-generation targeted drug aletinib had progression-free survival of 34.8 months, more than three times that of the first-generation drug crizotinib (trade name such as cyclozapine) (10.9 months). Aletinib has also arrived in China.
Other driver genes such as ROS1, PIK3, and MET are also being studied.
With the advent of immunotherapy, there is new hope for patients without driver gene mutations: if specific conditions are met, long-term survival is also possible with newer drugs using immunotherapy, with a 5-year survival rate that may be as high as 16%, which is 3 times higher than conventional therapy!
4. Other factors
Your physical and mental state, sensitivity to drugs, etc., can also affect outcomes and survival. In particular, the ability to actively participate and cooperate with treatment. In other words, “fate” is sometimes in your own hands.
Many patients believe that certain “miracle drugs” or “treasures of the ancestors” can cure tumors based on hearsay or “experience of acquaintances” within a few days after the doctor has determined the treatment plan and started treatment. In the end, they delayed or even aggravated the disease. In contrast, patients who have undergone standardized scientific treatment often have the chance to live longer and better.
In conclusion, the key to cure lung cancer lies in early diagnosis and early treatment. Low-dose spiral CT screening can improve the early diagnosis rate and cure early lung cancer through surgical resection. The pathological type, diagnostic stage, molecular type, patient’s physical and mental status and compliance are the key factors affecting the life time. Lung cancer is not a terminal disease, and with the continuous development of “precision medicine”, scientific and standardized treatment can bring new hope to patients with advanced disease.
Co-reviewed by: Guangdong Provincial People’s Hospital, Guangdong Provincial People’s Hospital Lung Cancer Institute, Dr. Yue-Li Sun, Dr. Lun-Xi Peng