Stage IV lung cancer was once considered almost hopeless, with very few patients surviving five years. But in the last decade, new treatments have significantly improved those odds. Today, more stage IV lung cancer patients are living longer – some well beyond five years – thanks to breakthroughs like targeted therapies and immunotherapy. This article explores the data behind these improved survival rates, explains why outdated statistics can be misleading, and shares inspiring stories of patients who have beaten the odds. The bottom line: there is real hope for stage IV lung cancer patients, as survival is improving year by year.

A Decade of Progress in Survival Rates
Not long ago, the five-year survival rate for stage IV (metastatic) lung cancer was shockingly low. Historically, only around 5–10% of people with distant-stage non-small cell lung cancer (NSCLC) were alive five years after diagnosis. In fact, before 2014, advanced NSCLC had a five-year survival rate of only 5% in the United States. Such dismal averages reflected the limited treatment options of the past.
Recent data, however, paint a much more hopeful picture. Due to rapid advances in treatment, the overall lung cancer five-year survival rate (all stages combined) rose to 26.6% by 2019, a 22% increase from just a few years prior. Crucially, this improvement is largely driven by better outcomes in advanced disease.
Why are the published “average” survival rates often outdated? Survival statistics typically lag by several years. They’re based on patients diagnosed in the past (for instance, 5-year survival for 2018 diagnoses). Thus, they may not include patients who benefited from the latest treatments. As new therapies become standard, the survival averages improve – but there’s a delay before those changes show up in official statistics. The encouraging reality is that outcomes for patients diagnosed today are better than the historical numbers suggest, and they continue to improve each year.
“Don’t look at the outdated averages – they don’t define your story.” Every patient is unique, and many factors (from tumor genetics to treatment advances) can drive survival well above the old statistics. In other words, there is genuine reason for hope.
Targeted Therapies: Personalizing Treatment for Better Outcomes
One of the biggest drivers of improved survival in stage IV lung cancer has been the rise of targeted therapies. These are pills or IV drugs that home in on specific genetic mutations or alterations in the cancer. About 20–30% of NSCLC patients have tumors with actionable mutations (such as changes in the EGFR gene, ALK gene rearrangements, ROS1 fusions, BRAF, RET, MET, etc.). For these patients, targeted drugs can produce dramatic, long-lasting responses that were rarely seen with older chemotherapy.
For instance, consider ALK-positive NSCLC, a subtype often affecting younger non-smokers. Traditional chemotherapy alone yielded poor long-term survival. But newer ALK inhibitors (targeted drugs blocking the ALK fusion) have completely changed the outlook. A recent clinical trial (the CROWN study) reported an astounding 5-year overall survival of ~76% for newly diagnosed ALK-positive patients who received the targeted drug lorlatinib as first-line therapy. In this trial, the median overall survival wasn’t even reached after 6 years of follow-up – meaning more than half of those patients were still alive beyond 6 years. This is a stunning improvement compared to a decade ago, when surviving even 2–3 years with ALK-positive metastatic lung cancer was uncommon.
Similarly, patients with EGFR mutations (another subgroup, often non-smokers or Asian ethnicity) have seen major gains. The latest EGFR-targeted medicine, osimertinib, has become standard first-line treatment worldwide. In the FLAURA trial, osimertinib improved median survival to 38.6 months (over 3 years), compared to ~31 months with older EGFR inhibitors. Many EGFR-mutant patients are now living 4, 5, or more years by sequencing through multiple targeted drugs and other therapies. A Japanese study of EGFR/ALK-positive patients found a 5-year survival rate of 28% in this group, with median survival about 3–4.5 years (longer for ALK, slightly shorter for EGFR). This is a dramatic rise considering that, historically, stage IV EGFR/ALK-positive patients rarely approached 5-year survival. Targeted therapies have essentially extended the lives of many of these patients by several years and, in some cases, a decade or more.
Other targets are following suit. ROS1 fusion-positive lung cancers respond well to crizotinib and newer TKIs, often yielding multi-year disease control. New drugs now exist for previously untargetable mutations like KRAS G12C, RET fusions, and MET exon14 skipping, offering fresh options that can prolong survival. As each new targeted therapy comes along, subsets of patients see their prognosis improve further. Many oncologists now mention that advanced NSCLC is becoming more like a “chronic disease” for patients who have a targetable driver mutation, managed over years with sequential therapies.
It’s worth noting that targeted drugs don’t usually “cure” stage IV cancer, but they can control the disease for long periods. Patients often transition through multiple lines: for example, starting on one targeted pill, then switching to another after resistance develops, and eventually using chemotherapy or other approaches. Each line can add more survival time. The result is that many patients are living far longer than before by leveraging all these treatments in sequence. As one survivor put it: “I wasn’t ready to give up – I wanted to explore all my options”, and by doing so, he lived to see treatments that rendered him cancer-free nearly 10 years later.
Immunotherapy: Harnessing the Immune System for Long-Term Remission
Another revolution in stage IV lung cancer has been immunotherapy, particularly drugs called immune checkpoint inhibitors. These medications (such as pembrolizumab/Keytruda, nivolumab/Opdivo, atezolizumab, etc.) help the patient’s own immune system recognize and attack the cancer. First approved around 2015, immunotherapies have since produced remarkable long-term survivors – even in patients without any “targetable” mutations.
The impact of immunotherapy is evident in clinical trial data. In the landmark KEYNOTE-024 trial for advanced NSCLC (which tested pembrolizumab first-line in patients whose tumors had high PD-L1 expression), the 5-year survival rate was 31.9% with pembrolizumab versus 16.3% with older chemotherapy. In other words, immunotherapy roughly doubled the five-year survival in that selected group. Dr. Martin Reck, a lead investigator, noted: “Before 2014, the five-year survival rate for advanced NSCLC was only 5%. Data [now] showed that 31.9% of patients treated with Keytruda were alive at five years – outcomes that did not seem possible to many oncologists, including myself, several years ago.” This highlights just how much things have changed in a short time.
Even patients with lower levels of PD-L1 (or none) are benefiting when immunotherapy is added to chemotherapy. The KEYNOTE-189 trial (non-squamous NSCLC) and KEYNOTE-407 (squamous NSCLC) demonstrated that combining pembrolizumab with chemo significantly boosts survival. At five years, about 19% of patients receiving the immunotherapy-chemo combo were alive, versus ~9–11% of those who received chemotherapy alone. This means many patients who previously had virtually no chance of long-term survival are now in that 1 in 5 group reaching five years. “These results show meaningful improvements in five-year survival… and reinforce the important role of Keytruda-based regimens as standard of care,” said Dr. Marina Garassino, reflecting on how the combination changed practice.
Furthermore, dual-immunotherapy combinations have pushed the envelope even more. The CheckMate-227 trial tested nivolumab + ipilimumab (a two-drug immunotherapy combo) in first-line metastatic NSCLC. At the 5-year follow-up, about 24% of patients with PD-L1 ≥1% treated with the dual immunotherapy were alive (versus 14% on chemo), and even in PD-L1 <1% patients, 19% were alive at 5 years with the combo (versus only 7% with chemo). This is nearly triple the survival in the PD-L1–negative group compared to chemo alone. Dr. Suresh Ramalingam, a lung oncologist involved in the study, stated: “Metastatic lung cancer [once had] a dismal historical five-year survival rate of ~6%. With extended follow-up, the dual immunotherapy results demonstrate impressive durability.” Many of these long-term survivors were even off treatment and cancer-free for years – truly unprecedented outcomes for lung cancer.
Importantly, immunotherapy has created a phenomenon of the “tail on the curve.” This refers to a subset of patients who respond exceptionally well and remain in remission for the long term. In trials, if a patient with stage IV NSCLC was able to complete two years of immunotherapy, there’s a very high chance (often 70–80% or more) that they will still be alive at five years. Some may even be functionally cured. For example, in KEYNOTE-024, among patients who finished the planned 2 years of pembrolizumab, 81.4% were alive at 5 years, and nearly half of them needed no further treatment beyond those two years. These numbers inspire tremendous hope, because they suggest that a fraction of patients achieve a deep, lasting remission.
It’s worth noting that not everyone responds to immunotherapy, and some cancers eventually progress after an initial response. However, ongoing research is identifying biomarkers (like PD-L1 level, tumor mutation burden, etc.) to predict who is most likely to benefit, and new strategies (such as combining different immunotherapies or adding treatments like radiation) to increase the response rate. Already, though, the advent of immunotherapy means that stage IV lung cancer is no longer an immediate death sentence for many patients – there is a real chance of surviving many years, especially if the cancer is immunotherapy-sensitive.
Next: Patient Savvy will soon be sharing positive case outcomes with ADC Dato-Dxd in lung cancer. Stay tuned and follow us for the latest updates!

Multiple Treatments and Continuous Advances
It’s important to understand that stage IV lung cancer treatment is rarely a single therapy given in isolation. Most patients will undergo a sequence of treatments over time: e.g., targeted therapy until it stops working, then perhaps chemotherapy + immunotherapy, then a trial drug, and so on. Each step can extend survival further. The goal for oncologists is to turn an initially dire prognosis into a series of manageable steps, keeping the cancer at bay with each new tool, until perhaps something comes along that produces a deeper remission. Download the latest treatment guidelines of NSCLC HERE.
This is why one should be cautious about interpreting survival rates by individual treatment alone. For example, a patient might start on a targeted EGFR inhibitor, stay stable for 2 years, then switch to chemo, and later immunotherapy – overall, they may end up living 5+ years but no single therapy was responsible for all of that time. Modern lung cancer care is very much a long-term journey, adjusting the strategy as the cancer changes. Many of the five-year survivors today are those who “used every option in the toolbox.” As one long-term survivor put it, “I had to prove all my doctors wrong. I am a fighter… I just want to tell people to NEVER ever give up hope! But you have to fight with all your might!” (as shared by Michelle, a stage IV survivor in a patient forum).
Another factor improving survival is better management of metastases. Stage IV means cancer has spread, but if it’s only spread to a limited number of spots (oligometastatic disease), aggressive local treatments like surgery or stereotactic radiation can sometimes eradicate those spots. In select cases, this can lead to no evidence of disease. For instance, surgery is usually not offered for stage IV, but at specialty centers, doctors now sometimes operate after a great response to systemic therapy. An example is patient Keegan M., who was diagnosed with stage IV ALK-positive lung cancer at 41. He received an ALK-targeted drug (alectinib) that shrank his tumors by 50% in two months, which made surgery possible. A thoracic surgeon removed two lobes of his lung, and the pathology report showed no living cancer cells – he had a complete pathological response. “Even my doctors were shocked. The cancer was completely gone… It was unbelievable,” Keegan recalls. He went from having tumors in his lungs, lymph nodes, ribs, and abdomen to no evidence of disease (NED) in just six months. Cases like this, while not common, show that with the right treatment plan, stage IV can sometimes be pushed into remission. As Keegan says, “Going from a stage IV lung cancer diagnosis to no evidence of disease is nothing short of a miracle… I didn’t think I could ever be cancer-free, much less that fast. And I am so incredibly grateful.”
Stories of Hope
Perhaps the most inspiring evidence of progress comes from the voices of survivors themselves. Hearing from those who have lived years beyond a stage IV diagnosis can provide enormous hope to patients and families currently facing it. Here are a few such stories that highlight the human side of these statistics:
- Ed’s Story (American Lung Association): Ed, a husband and father, was diagnosed with stage IV NSCLC with spread to his liver in 2012. Initially, he had no targetable mutations, so he underwent chemotherapy. When chemo stopped working, Ed enrolled in a Phase I immunotherapy trial. The first trial drug caused harsh side effects, but Ed and his oncologist didn’t give up – he switched to a different immunotherapy trial. Within a year, Ed’s disease stabilized, and incredibly, it has stayed under control for years. “Both my wife and I were scared… I was afraid I was going to miss seeing my grandchildren grow up,” Ed admits, recalling his feelings when chemo failed. But the clinical trial changed everything: five years after starting immunotherapy, Ed was not only alive – in April 2022, he was declared ‘no evidence of disease’ (cancer-free). Now over a decade post-diagnosis, Ed is enjoying life and advocacy. “There is hope. We are living long lives now, long fruitful lives where we can enjoy being with our family,” he says. Ed emphasizes the importance of getting a biomarker test (to find any mutations) and seeking second opinions. He was originally told he might only have 9–12 months to live – that was nearly 10 years ago, and Ed is here to tell others that with determination and newer treatments, outcomes can be far better than expected.
- Keegan’s Story (MD Anderson Cancer Center): We mentioned Keegan earlier – a former firefighter diagnosed in 2022 with ALK-positive stage IV lung cancer. The combination of a targeted drug and an innovative surgical approach left him cancer-free in 2023. Keegan’s story is remarkable not just for his rapid complete response, but also for his outlook. “In my mind, going from a stage IV diagnosis to NED is nothing short of a miracle,” he says. Now in his early 40s, Keegan had to retire from firefighting, but he feels great and is even training for an Ironman triathlon. “I feel so good now… I’ve been savoring my time with family and friends,” he shares, grateful for the treatment that gave him his life back. His advice to others: seek out expert care (in his case, traveling to a top cancer center with ALK specialists) and don’t lose hope, because the impossible can happen.
These stories, and many others like them, reinforce the article’s main message: don’t be overly discouraged by old survival stats. Lung cancer treatment is evolving rapidly, and each patient’s trajectory can be very different. As one survivor put it, “I had to prove all my doctors wrong. I’m a fighter… NEVER ever give up hope!”. Where one person might see a 5% survival chance, another person – with the right treatment at the right time – might actually have a 50% or better chance.
It should also be mentioned that attitude and advocacy can play a role. Many survivors speak of the importance of staying hopeful but proactive – educating oneself, asking about molecular testing, getting second opinions at major cancer centers, and considering clinical trials when appropriate. While hope alone can’t cure cancer, it can drive patients and families to seek out the best possible care and not give up, even if one treatment fails.
Looking Ahead: Real Hope for Patients and Caregivers
The improvements in 5-year survival for stage IV lung cancer over the last decade are truly remarkable. What used to be a rare achievement – to live five years with advanced lung cancer – is becoming increasingly common. And for certain subgroups of patients, five-year survival is now expected in a significant portion, something that was unheard of before.
For patients and caregivers facing a stage IV lung cancer diagnosis today, the key messages are hope and empowerment. Do not be trapped by outdated statistics that say “only X% survive five years,” because those numbers might not apply to you or to the current treatment landscape. Many factors – your tumor’s genetics, your overall health, the treatments you pursue – influence your individual prognosis. As we’ve seen, people given just months to live have gone on to enjoy many more years of life, even achieving complete remission.
“At my first appointment, I was told I had 9–12 months,” a patient recalls, “But I wasn’t ready to give up… That was nearly 10 years ago.” Each year, new breakthroughs are turning stage IV lung cancer into a more survivable condition.
In closing, while stage IV lung cancer remains a very serious diagnosis, it is no longer the hopeless scenario it once was. The five-year survival rate has significantly improved, and continues to improve, because of ongoing advances in science and medicine. Patients and caregivers should feel encouraged by the progress made in the last decade – progress that is delivering more time, better quality of life, and even the possibility of long-term remission. By staying informed, seeking personalized care, and never losing hope, patients can maximize their chances of becoming one of the success stories. As the lung cancer community often says, and as the emerging data affirms: “Hope” is truly alive and well for stage IV lung cancer patients today.
Sources:
- American Lung Association – State of Lung Cancer 2023 report (survival statistics)
- Journal for ImmunoTherapy of Cancer (2023) – Determinants of 5-year survival in advanced NSCLC (SEER data and study of long-term survivors)
- Merck (Keytruda) Press Release (2020) – Five-year outcomes of KEYNOTE-024 trial (immunotherapy vs chemo in PD-L1 high NSCLC)
- Merck Press Release (2022) – Five-year outcomes of KEYNOTE-189 and 407 (Keytruda + chemo)
- Bristol Myers Squibb Press Release (2022) – Five-year outcomes of CheckMate-227 (Opdivo + Yervoy combo)
- BMC Cancer (2022) – Survival beyond five years in EGFR-mutated or ALK-rearranged NSCLC (real-world outcomes)
- MD Anderson Cancer Center – Keegan Murphy’s stage IV lung cancer survivor story (ALK+ targeted therapy + surgery)
- American Lung Association Blog – Ed’s personal story of surviving stage IV lung cancer with immunotherapy
- GO2 for Lung Cancer – Wells’s 26-year survivor story (aggressive multimodal treatment and early targeted therapy use)
- Martin Reck, MD (oncologist) quote on long-term immunotherapy surviva and patient quotes from survivor stories, as cited above.