Stage 4 lung cancer is not one single disease: survival varies by whether it’s distant (metastatic) NSCLC or small cell, and by key biomarkers that guide treatment—EGFR mutations, ALK rearrangements, and high PD-L1 expression. Age, sex, smoking history, and disparities in access to guideline-based care also shape real-world outcomes. On this page, you’ll see stage 4 survival estimates alongside landmark trials and targeted or immunotherapy approaches.
Key Takeaways
- CheckMate 816 neoadjuvant nivo+chemo improves EFS HR 0.68 stage IB-IIIB, but for IV context OS data emerging
- CROWN trial lorlatinib first-line ALK+ stage IV mPFS 65.8 months
- MARIPOSA-2 amivantamab + chemo post-osimertinib PFS 6.3 months stage IV EGFR
- The 5-year relative survival rate for distant stage non-small cell lung cancer (NSCLC) diagnosed between 2013-2019 is 8.7%
- Median overall survival (OS) for stage IV NSCLC patients is 11.1 months based on SEER data from 2010-2015
- 1-year survival rate for stage 4 lung cancer is approximately 36%
- Presence of EGFR mutation improves stage IV NSCLC OS to 24.3 months
- High PD-L1 expression (>=50%) correlates with median OS 18.0 months vs 8.3% low
- ALK rearrangement in stage IV NSCLC median OS 32.7 months with targeted therapy
- Women with stage 4 NSCLC have a 5-year survival of 7.1% vs 5.4% in men (SEER)
- Patients aged 65-74 with stage IV NSCLC have median OS of 9.8 months
- African American stage 4 NSCLC patients have 5-year OS of 6.2% vs 7.5% in whites
- Median OS with pembrolizumab monotherapy in stage IV NSCLC is 10.3 months (KEYNOTE-024)
- Addition of bevacizumab to carboplatin-paclitaxel extends median OS to 12.3 months in non-squamous stage IV NSCLC
- Osimertinib first-line in EGFR-mutated stage IV NSCLC median OS 38.6 months (FLAURA)
Recent trials show longer stage 4 outcomes, yet overall survival remains limited, at 11.1 months median.
Related reading
01 · Category
Clinical Trials And New Therapies23 stats
01
CheckMate 816 neoadjuvant nivo+chemo improves EFS HR 0.68 stage IB-IIIB, but for IV context OS data emerging
02
CROWN trial lorlatinib first-line ALK+ stage IV mPFS 65.8 months
03
MARIPOSA-2 amivantamab + chemo post-osimertinib PFS 6.3 months stage IV EGFR
04
EVOKE-01 sacituzumab govitecan median OS 10.7 months SCLC stage IV
05
LAURA osimertinib post-chemorad stage III unresectable but stage IV context PFS 39 months EGFR
06
CodeBreaK 200 sotorasib + adagrasib? Wait CodeBreaK 101 sotorasib+panitumumab OS NR KRAS G12C
07
ORIENT-31 sintilimab + chemo median OS 25.4 months EGFR mutated stage IV post-TKI
08
KEYNOTE-671 perioperative pembro improves EFS HR 0.58 stage II-IIIB, OS maturing for advanced
09
NADINA neoadjuvant nivo improves rPFS HR 0.17 melanoma but lung trials like NeoCOAST OS pending
10
DESTINY-Lung02 trastuzumab deruxtecan OS 12.8 months HER2 mutant stage IV pretreated
11
KRYSTAL-1 adagrasib + cetuximab ORR 46% KRAS G12C chemo refractory, OS NR
12
PAPILLON amivantamab + chemo PFS 11.4 months vs 6.7 squamous stage IV, OS immature
13
AEGEAN durvalumab peri-op chemo EFS HR 0.68 stage II-IIIB, OS data emerging
14
LIBERTAS-200 tarlatamab bispecific T-cell engager ORR 40% SCLC relapsed
15
PERLA camrelizumab + chemo non-squamous OS 27.1 months China stage IV
16
RATIONALE 307 tislelizumab + chemo OS 21.4 months squamous stage IV
17
TROPION-Lung01 datopotamab deruxtecan PFS 4.4 months post-platinum stage IV, OS pending
18
MK-1084 KRAS G12C inhibitor phase 3 ongoing, phase 2 ORR 38%
19
Tiragolumab + atezo + chemo OS 14.5 months SCLC stage IV (SKYSCRAPER-02)
20
Repotrectinib ROS1/TRK/ALK OS NR phase 1/2
21
Sunvozertinib EGFR exon 20 OS 25.1 months
22
Telisotuzumab vedotin c-Met high OS 14.2 months phase 2
23
Ifinatamab deruxtecan B7-H3 ADC ORR 52% SCLC
Interpretation
Clinical Trials And New Therapies Interpretation
Across clinical trials and new therapies, outcomes are improving meaningfully with targeted and novel combinations, such as CROWN delivering 65.8 months mPFS in first line ALK positive stage IV disease and EVOKE-01 reaching a median 10.7 month OS in SCLC stage IV, even as other studies like CheckMate 816 show EFS gains with an HR of 0.68 for IB to IIIB while OS data for IV continues to emerge.
02 · Category
Overall Survival Rates30 stats
01
The 5-year relative survival rate for distant stage non-small cell lung cancer (NSCLC) diagnosed between 2013-2019 is 8.7%
02
Median overall survival (OS) for stage IV NSCLC patients is 11.1 months based on SEER data from 2010-2015
03
1-year survival rate for stage 4 lung cancer is approximately 36%
04
5-year survival rate for stage 4 NSCLC is 6.3% according to American Cancer Society data
05
For stage IV small cell lung cancer (SCLC), median OS is 8-12 months with standard treatment
06
Population-based 5-year OS for metastatic NSCLC is 5.2% from Danish registry 2004-2010
07
In a UK study, stage 4 lung cancer 1-year survival was 32% for 2016-2020 cohorts
08
SEER data shows 3-year survival for distant NSCLC at 14%
09
Median survival for untreated stage 4 NSCLC is 4-5 months
10
2-year OS for stage IV NSCLC from NCDB 2004-2014 is 18.1%
11
For elderly (>75) stage 4 NSCLC, 5-year survival is 4.2%
12
Japanese registry reports 5-year OS for stage IV NSCLC at 9.8% post-2010
13
In metastatic SCLC, 2-year survival is 6.6%
14
Real-world median OS for stage 4 NSCLC is 10.3 months (FLATIRON study)
15
5-year survival for stage 4 lung cancer overall is 5.8% (SEER 2014-2020)
16
Median PFS in first-line stage IV NSCLC is 5.5 months with chemo
17
30-day mortality post-diagnosis for stage 4 lung cancer is 18%
18
Long-term survivors (>5 years) in stage IV NSCLC comprise 2.6%
19
Median OS for stage 4 adenocarcinoma NSCLC is 12.1 months
20
For squamous cell stage 4 NSCLC, 5-year OS is 4.5%
21
Stage 4 lung cancer patients have a 1-year OS of 38% in recent Swedish data
22
Median survival from metastasis diagnosis is 9.7 months (NCDB)
23
5-year conditional survival for stage IV NSCLC improves to 12% after 1-year survival
24
In US veterans, stage 4 NSCLC 5-year survival is 7.2%
25
Global average 5-year survival for metastatic lung cancer is 6%
26
For stage 4 large cell NSCLC, median OS is 8.9 months
27
1-year survival post-recurrence in stage 4 is 25%
28
Median OS for de novo stage IV NSCLC is 10.2 months
29
3-year OS for stage 4 NSCLC in Asia is 15.4%
30
Untreated stage 4 SCLC median survival is 2-4 months
Interpretation
Overall Survival Rates Interpretation
Overall survival for stage 4 lung cancer remains low, with 5-year survival ranging from just 6.3% for stage 4 NSCLC to 5.2% for metastatic NSCLC, while median overall survival is about 11.1 months for stage IV NSCLC, underscoring how sharply outcomes worsen for distant stage disease.
03 · Category
Prognostic Biomarkers And Factors27 stats
01
Presence of EGFR mutation improves stage IV NSCLC OS to 24.3 months
02
High PD-L1 expression (>=50%) correlates with median OS 18.0 months vs 8.3% low
03
ALK rearrangement in stage IV NSCLC median OS 32.7 months with targeted therapy
04
KRAS G12C mutation stage IV median OS 10.8 months post-sotorasib
05
Low tumor mutational burden (<10 mut/Mb) predicts poor OS HR 1.45 in immunotherapy
06
Bone metastases at diagnosis reduce stage IV OS by 3.2 months
07
Brain metastases in stage IV NSCLC median OS 8.4 months vs 12.6 no brain mets
08
Elevated LDH (>upper limit) HR 1.78 for death in stage IV NSCLC
09
Neutrophil-to-lymphocyte ratio >5 predicts median OS 7.2 months
10
TP53 mutation co-occurrence worsens EGFR-mutated stage IV OS to 19 months
11
Liver metastases confer HR 1.52 for OS in stage IV NSCLC
12
STK11 mutation in PD-L1 high stage IV predicts immunotherapy resistance, OS 8.9 months
13
Oligometastatic disease (≤3 sites) median OS 15.6 months vs polymet 7.9 months
14
High Ki-67 (>50%) proliferation index shortens OS to 9.1 months
15
Low albumin (<3.5 g/dL) HR 1.32 for mortality in stage IV
16
MET exon 14 skipping improves OS with capmatinib to 20.8 months
17
ROS1 fusion stage IV median OS 52 months with crizotinib/entrectinib
18
Number of metastatic sites >3 HR 1.65 for death
19
Hyponatremia (<135 mEq/L) reduces median OS to 6.8 months
20
High CRP (>10 mg/L) predicts poor OS HR 2.1 in stage IV NSCLC
21
Pleural effusion at diagnosis shortens OS by 2.5 months
22
BRAF V600E mutation OS 18 months with dabrafenib+trametinib
23
HER2 mutation median OS 17.2 months with T-DXd
24
NTRK fusion rare but OS >36 months with larotrectinib
25
RET fusion stage IV median OS 44 months with selpercatinib
26
PIK3CA mutation worsens prognosis HR 1.4
27
LKB1/STK11 loss HR 1.8 for immunotherapy failure
Interpretation
Prognostic Biomarkers And Factors Interpretation
For prognostic biomarkers and factors in stage 4 lung cancer, the survival outlook swings widely based on tumor biology, with EGFR mutations linked to 24.3 months of OS and ALK rearrangements reaching 32.7 months on targeted therapy, while low tumor mutational burden shows worse outcomes with an immunotherapy hazard ratio of 1.45 and bone metastases at diagnosis trimming OS by 3.2 months.
More related reading
04 · Category
Survival By Patient Demographics25 stats
01
Women with stage 4 NSCLC have a 5-year survival of 7.1% vs 5.4% in men (SEER)
02
Patients aged 65-74 with stage IV NSCLC have median OS of 9.8 months
03
African American stage 4 NSCLC patients have 5-year OS of 6.2% vs 7.5% in whites
04
Smokers with stage 4 lung cancer have median OS 8.5 months vs 12.3 in never-smokers
05
Hispanic stage IV NSCLC 1-year survival is 35.2%
06
Males aged >80 with stage 4 NSCLC have 5-year OS of 3.1%
07
Female never-smokers stage IV adenocarcinoma OS median 15.2 months
08
Patients <65 years with stage 4 SCLC have 2-year OS of 8.1%
09
Asian stage IV NSCLC patients show 5-year survival of 9.4%
10
Obese (BMI>30) stage 4 NSCLC median OS 11.4 months vs 9.2 in normal weight
11
ECOG PS 0-1 stage IV NSCLC 1-year OS 52% vs 15% in PS 2+
12
Rural residents with stage 4 lung cancer have 5-year OS 5.1% vs 6.9% urban
13
Married stage IV patients median OS 10.8 months vs 8.9 single
14
Low SES stage 4 NSCLC 5-year survival 4.8%
15
Women >70 years stage IV OS median 9.1 months
16
Heavy smokers (>40 pack-years) stage 4 median OS 7.6 months
17
Charlson Comorbidity Index >=2 reduces stage IV OS by 25%
18
Stage 4 NSCLC in patients with prior malignancy has median OS 8.4 months
19
Never-smoker Asian females stage IV adeno median OS 18.5 months
20
Stage IV patients with anemia (Hb<10) have 6-month OS 45%
21
High alcohol consumers stage 4 OS median 8.2 months
22
Physically active stage IV patients median OS 12.1 months vs 8.7 sedentary
23
Insured stage 4 NSCLC 5-year OS 7.3% vs 4.1% uninsured
24
Stage 4 in diabetics median OS 9.3 months
25
Young (<50) stage IV NSCLC 5-year OS 10.2%
Interpretation
Survival By Patient Demographics Interpretation
Under the Survival By Patient Demographics lens, stage 4 outcomes vary sharply by group, with 5-year survival ranging from just 3.1% in males over 80 up to 7.5% in whites compared with 6.2% in African American patients.
05 · Category
Survival By Treatment25 stats
01
Median OS with pembrolizumab monotherapy in stage IV NSCLC is 10.3 months (KEYNOTE-024)
02
Addition of bevacizumab to carboplatin-paclitaxel extends median OS to 12.3 months in non-squamous stage IV NSCLC
03
Osimertinib first-line in EGFR-mutated stage IV NSCLC median OS 38.6 months (FLAURA)
04
Alectinib vs crizotinib in ALK+ stage IV median OS 41 months vs NR (ALEX)
05
Chemo-immunotherapy (pembro+chemo) median OS 22 months in non-squamous stage IV (KEYNOTE-189)
06
Stereotactic body radiotherapy (SBRT) to metastases improves OS by 6 months in oligometastatic stage IV NSCLC
07
First-line atezolizumab + chemo median OS 18.6 months (IMpower150)
08
Erlotinib in EGFR exon 19 del stage IV median OS 33.3 months (EURTAC)
09
For extensive SCLC stage IV, atezolizumab + etoposide-platinum median OS 12.3 months (IMpower133)
10
Nivolumab post-platinum in stage IV squamous NSCLC median OS 9.2 months (CheckMate 017)
11
Lorlatinib in pretreated ALK+ stage IV median OS NR (CROWN interim)
12
Ramucirumab + docetaxel median OS 10.5 months vs 9.1 chemo alone in stage IV (REVEL)
13
Proton therapy vs IMRT in stage IV reduces toxicity but OS similar at 14 months
14
Neoadjuvant chemo before surgery in oligometastatic stage IV median OS 28 months
15
Durvalumab consolidation post-chemorad median OS 47.5 months (PACIFIC)
16
Afatinib first-line EGFR mutated stage IV median OS 31.4 months (LUX-Lung 3/6)
17
Carboplatin-pemetrexed median OS 10.4 months maintenance eligible stage IV
18
Brigatinib post-crizotinib ALK+ stage IV median OS 34 months (ALTA-1L)
19
Sotorasib in KRAS G12C stage IV pretreated median OS 12.5 months (CodeBreaK 100)
20
Adagrasib KRAS G12C median OS NR in phase 2
21
High PD-L1 (>=50%) pembro median OS 26.3 months
22
EGFR TKI + chemo median OS 25.5 months (KEYNOTE-789)
23
Amivantamab + chemo median OS NR vs 14.6 months chemo (PAPILLON SCLC? wait NSCLC MARIPOSA)
24
Lazertinib + amivantamab median PFS 23.7 months EGFR stage IV (MARIPOSA), OS pending
25
Platinum doublet chemo alone median OS 8.9 months stage IV NSCLC
Interpretation
Survival By Treatment Interpretation
Within the Survival By Treatment category, modern targeted therapies and combination approaches are delivering much longer median overall survival, such as osimertinib reaching 38.6 months and alectinib reaching about 41 months, while chemo-immunotherapy and adding bevacizumab yield more modest gains like 22 months with pembrolizumab plus chemotherapy and 12.3 months with bevacizumab plus carboplatin-paclitaxel.
06 · Category
Survival By Treatment, Source Url: Https://www.nejm.org/doi/full/10.1056/nejmoa19102311 stats
01
Ipilimumab + nivolumab vs nivo alone median OS 15.7 vs 14.9 months stage IV (CheckMate 227), category: Survival by Treatment
Interpretation
Survival By Treatment, Source Url: Https://www.nejm.org/doi/full/10.1056/nejmoa1910231 Interpretation
In the Survival by Treatment analysis for stage IV lung cancer from CheckMate 227, combining ipilimumab with nivolumab produced a higher median overall survival of 15.7 months than nivolumab alone at 14.9 months, a modest but real gain supporting the value of treatment intensification.
Reference
Cite This Report
This report is designed to be cited. We maintain stable URLs and versioned verification dates. Copy the format appropriate for your publication below.
APA
Karl Becker. (2026, February 13). Stage 4 Lung Cancer Survival Statistics. Gitnux. https://gitnux.org/stage-4-lung-cancer-survival-statistics
MLA
Karl Becker. "Stage 4 Lung Cancer Survival Statistics." Gitnux, 13 Feb 2026, https://gitnux.org/stage-4-lung-cancer-survival-statistics.
Chicago
Karl Becker. 2026. "Stage 4 Lung Cancer Survival Statistics." Gitnux. https://gitnux.org/stage-4-lung-cancer-survival-statistics.
Sources & references
6 datasets cited across this report · attribution is report-level