# Overall survival (OS)

Source: https://onco.cc/terms/os/  
OnCo record `os` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Overall survival (OS) is how long patients live, full stop. It is the gold-standard endpoint.

## Summary

Overall survival (OS) is the time from random assignment to death from any cause, and it remains the gold-standard endpoint in oncology trials. Its interpretation is confounded by crossover and by therapies given after progression, and it requires long follow-up. Regulators increasingly want to see that OS is not harmed even when PFS is the primary endpoint. The term is cited by the Small-cell lung cancer and Hodgkin lymphoma entries, the ZUMA-7 trial and Michael LeBlanc, and it runs through the bottlenecks on trial design, weak real-world evidence, patient voice and quality of life. Related ideas include randomising the next line of treatment before the first fails, a regulatory endpoint for antimetastatic drugs and seamless phase 2/3 trials with pre-registered go rules.

## Fields

- Kind: Term
- Last checked: 2026-09-04
- Also known as: OS; overall-survival; mOS; survival benefit; survival advantage; survival detriment; live longer; lived longer; longer survival; death from any cause

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Survival_rate
- Wikipedia: https://en.wikipedia.org/wiki/Survival_rate

## Connected records

- terms: [Absolute versus relative benefit (number needed to treat)](https://onco.cc/terms/absolute-benefit/), [Clinical benefit response (the gemcitabine trial endpoint)](https://onco.cc/terms/clinical-benefit-response/), [Crossover in trials](https://onco.cc/terms/crossover/), [Data maturity (immature vs mature survival data)](https://onco.cc/terms/data-maturity/), [Endpoint](https://onco.cc/terms/endpoint/), [Estimands and intercurrent events (ICH E9(R1))](https://onco.cc/terms/estimand/), [Event-free / disease-free survival (EFS, DFS, iDFS, RFS)](https://onco.cc/terms/efs/), [Hazard ratio (HR)](https://onco.cc/terms/hazard-ratio/), [Kaplan-Meier curve, censoring and proportional hazards](https://onco.cc/terms/kaplan-meier-curve/), [Landmark and milestone survival (5-year survival, median follow-up)](https://onco.cc/terms/landmark-survival/), [Median survival](https://onco.cc/terms/median-survival/), [Mortality](https://onco.cc/terms/mortality/), [Primary, secondary and co-primary endpoints](https://onco.cc/terms/primary-endpoint/), [Prognosis](https://onco.cc/terms/prognosis/), [Progression-free survival (PFS)](https://onco.cc/terms/pfs/), [Quality-adjusted survival (QALYs and Q-TWiST)](https://onco.cc/terms/quality-adjusted-survival/), [Reading a hazard ratio](https://onco.cc/terms/hazard-ratio-basics/), [Remission](https://onco.cc/terms/remission/), [Surrogate endpoint](https://onco.cc/terms/surrogate-endpoint/), [Surrogate endpoint validation: which stand-ins have earned trust](https://onco.cc/terms/surrogate-validation/), [Survival outcomes as time plus event (OS, PFS)](https://onco.cc/terms/os-pfs-time-event/), [Time to progression (TTP) and time to next treatment (TTNT)](https://onco.cc/terms/ttp/)
- trials: [ADAURA](https://onco.cc/trials/adaura/), [CHALLENGE (CCTG CO.21)](https://onco.cc/trials/challenge/), [CheckMate 067](https://onco.cc/trials/checkmate-067/), [Elective vs therapeutic neck dissection in node-negative oral cancer (Tata Memorial)](https://onco.cc/trials/elective-neck-dissection-tmh/), [KEYNOTE-564](https://onco.cc/trials/keynote-564/), [Low-dose nivolumab plus metronomic chemotherapy (Tata Memorial)](https://onco.cc/trials/low-dose-nivolumab-tmh/), [Peritumoral lidocaine before breast cancer surgery (Tata Memorial)](https://onco.cc/trials/lidocaine-peritumoral-tmh/), [TROPION-Breast01](https://onco.cc/trials/tropion-breast01/), [ZUMA-7](https://onco.cc/trials/zuma-7/)
- cancers: [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Small-cell lung cancer](https://onco.cc/cancers/sclc/)
- key papers: [ADAURA: exploratory eight-year overall survival update for adjuvant osimertinib in resected EGFR-mutated stage IB to IIIA lung cancer](https://onco.cc/key-papers/paper-adaura-8-year-os-jto-2026/), [ADMIRAL: gilteritinib pills versus chemotherapy for relapsed FLT3-mutated acute myeloid leukaemia](https://onco.cc/key-papers/paper-admiral-gilteritinib-flt3-nejm-2019/), [ADRIATIC: durvalumab after chemoradiotherapy for limited-stage small-cell lung cancer](https://onco.cc/key-papers/paper-adriatic-nejm-2024/), [AGILE: ivosidenib plus azacitidine for newly diagnosed IDH1-mutated AML in patients unfit for intensive chemotherapy](https://onco.cc/key-papers/paper-agile-ivosidenib-azacitidine-nejm-2022/), [ASCENT: sacituzumab govitecan doubles survival in heavily pretreated metastatic triple-negative breast cancer](https://onco.cc/key-papers/paper-ascent-nejm-2021/), [BREAKWATER: encorafenib plus cetuximab with chemotherapy as first treatment for BRAF V600E-mutated colorectal cancer](https://onco.cc/key-papers/paper-breakwater-nejm-2025/), [Burris 1997: gemcitabine becomes the first standard treatment for advanced pancreatic cancer](https://onco.cc/key-papers/paper-burris-gemcitabine-pancreatic-jco-1997/), [Capivasertib plus paclitaxel as first-line treatment for metastatic triple-negative breast cancer: results from the randomised, global phase III CAPItello-290 trial](https://onco.cc/key-papers/paper-capitello-290-capivasertib-paclitaxel-ann-oncol-2026/), [CARTITUDE-4: cilta-cel CAR-T versus standard combinations after one to three prior lines of myeloma therapy](https://onco.cc/key-papers/paper-cartitude-4-cilta-cel-nejm-2023/), [CheckMate 017: nivolumab beats docetaxel in squamous lung cancer after chemotherapy](https://onco.cc/key-papers/paper-checkmate-017-nejm-2015/), [CheckMate 057: nivolumab beats docetaxel after chemotherapy in non-squamous lung cancer](https://onco.cc/key-papers/paper-checkmate-057-nejm-2015/), [CheckMate 067 at ten years: nivolumab plus ipilimumab produces long-term survival in half of patients with advanced melanoma](https://onco.cc/key-papers/paper-checkmate-067-10-year-nejm-2025/), [CheckMate 649: nivolumab plus chemotherapy as first treatment for advanced gastric, gastro-oesophageal junction and oesophageal adenocarcinoma](https://onco.cc/key-papers/paper-checkmate-649-lancet-2021/), [CLEAR: lenvatinib plus pembrolizumab versus sunitinib as first treatment for advanced kidney cancer](https://onco.cc/key-papers/paper-clear-nejm-2021/), [CodeBreaK 200: sotorasib versus docetaxel in KRAS G12C-mutated lung cancer, a modest win for the first KRAS drug](https://onco.cc/key-papers/paper-codebreak-200-lancet-2023/), [Conroy 2011: FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer (PRODIGE 4/ACCORD 11)](https://onco.cc/key-papers/paper-conroy-folfirinox-pancreatic-nejm-2011/), [Datopotamab deruxtecan in patients with untreated, advanced triple-negative breast cancer (TROPION-Breast02): a randomised, open-label, international, phase III trial](https://onco.cc/key-papers/paper-tropion-breast02-ann-oncol-2026/), [DESTINY-Breast03: trastuzumab deruxtecan beats T-DM1 as second-line treatment of HER2-positive metastatic breast cancer](https://onco.cc/key-papers/paper-destiny-breast03-nejm-2022/), [DESTINY-Breast04: trastuzumab deruxtecan works in HER2-low breast cancer, creating a new treatable group](https://onco.cc/key-papers/paper-destiny-breast04-nejm-2022/), [Durvalumab plus chemotherapy in advanced biliary tract cancer: 3-year overall survival update from the phase III TOPAZ-1 study](https://onco.cc/key-papers/paper-topaz-1-three-year-survival-j-hepatol-2025/), [ECHELON-1: brentuximab vedotin replacing bleomycin in first-line chemotherapy for advanced Hodgkin lymphoma](https://onco.cc/key-papers/paper-echelon-1-brentuximab-avd-nejm-2018/), [ECOG-ACRIN E1910: adding blinatumomab to chemotherapy for adults with B-cell ALL already in MRD-negative remission](https://onco.cc/key-papers/paper-e1910-blinatumomab-mrd-negative-all-nejm-2024/), [EV-302: enfortumab vedotin plus pembrolizumab replaces chemotherapy as first treatment for advanced bladder cancer](https://onco.cc/key-papers/paper-ev-302-nejm-2024/), [Five-Year Outcomes of FOLFIRINOX vs Gemcitabine as Adjuvant Therapy for Pancreatic Cancer: A Randomized Clinical Trial](https://onco.cc/key-papers/paper-prodige-24-five-year-outcomes-jama-oncol-2022/), [FLAURA: osimertinib as first treatment for EGFR-mutated lung cancer](https://onco.cc/key-papers/paper-flaura-nejm-2018/), [HARMONi-2: ivonescimab, a PD-1 x VEGF bispecific, beats pembrolizumab head-to-head in PD-L1-positive lung cancer](https://onco.cc/key-papers/paper-harmoni-2-lancet-2025/), [Hodi 2010: ipilimumab, the first checkpoint inhibitor, extends survival in metastatic melanoma](https://onco.cc/key-papers/paper-hodi-ipilimumab-melanoma-nejm-2010/), [Hurwitz 2004: bevacizumab with chemotherapy for metastatic colorectal cancer, the first anti-angiogenic drug to extend life](https://onco.cc/key-papers/paper-hurwitz-bevacizumab-crc-nejm-2004/), [IMbrave150: atezolizumab plus bevacizumab replaces sorafenib as first treatment for advanced liver cancer](https://onco.cc/key-papers/paper-imbrave150-nejm-2020/), [INO-VATE: inotuzumab ozogamicin, a CD22 antibody-drug conjugate, versus chemotherapy for relapsed adult B-cell ALL](https://onco.cc/key-papers/paper-ino-vate-inotuzumab-all-nejm-2016/), [IRIS: imatinib versus interferon plus cytarabine as first treatment for chronic myeloid leukaemia](https://onco.cc/key-papers/paper-iris-imatinib-nejm-2003/), [KEYNOTE-006 (Robert 2015): pembrolizumab versus ipilimumab in advanced melanoma](https://onco.cc/key-papers/paper-keynote-006-pembrolizumab-ipilimumab-melanoma-nejm-2015/), [KEYNOTE-010 (Herbst 2016): pembrolizumab versus docetaxel in previously treated PD-L1-positive lung cancer](https://onco.cc/key-papers/paper-keynote-010-lancet-2016/), [KEYNOTE-024: pembrolizumab alone beats chemotherapy in PD-L1-high lung cancer](https://onco.cc/key-papers/paper-keynote-024-nejm-2016/), [KEYNOTE-048: pembrolizumab, alone or with chemotherapy, as first treatment for recurrent or metastatic head and neck cancer](https://onco.cc/key-papers/paper-keynote-048-lancet-2019/), [KEYNOTE-177: pembrolizumab instead of chemotherapy as first treatment for mismatch-repair-deficient metastatic colorectal cancer](https://onco.cc/key-papers/paper-keynote-177-nejm-2020/), [KEYNOTE-189: pembrolizumab plus chemotherapy as first treatment for non-squamous lung cancer without a driver mutation](https://onco.cc/key-papers/paper-keynote-189-nejm-2018/), [KEYNOTE-564: a year of pembrolizumab after kidney cancer surgery](https://onco.cc/key-papers/paper-keynote-564-nejm-2021/), [KEYNOTE-A18: pembrolizumab with chemoradiotherapy for locally advanced cervical cancer (overall survival)](https://onco.cc/key-papers/paper-keynote-a18-os-lancet-2024/), [KEYNOTE-A18: pembrolizumab with chemoradiotherapy for locally advanced cervical cancer (progression-free survival)](https://onco.cc/key-papers/paper-keynote-a18-pfs-lancet-2024/), [MAIA: adding daratumumab to lenalidomide-dexamethasone for older patients with newly diagnosed myeloma who cannot have a transplant](https://onco.cc/key-papers/paper-maia-daratumumab-rd-nejm-2019/), [MARIPOSA: amivantamab plus lazertinib versus osimertinib as first treatment for EGFR-mutated lung cancer](https://onco.cc/key-papers/paper-mariposa-nejm-2024/), [MPACT (Von Hoff 2013): nab-paclitaxel plus gemcitabine for metastatic pancreatic cancer](https://onco.cc/key-papers/paper-mpact-nab-paclitaxel-gemcitabine-nejm-2013/), [MURANO: two years of venetoclax plus rituximab versus chemo-immunotherapy in relapsed CLL](https://onco.cc/key-papers/paper-murano-venetoclax-rituximab-nejm-2018/), [Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial](https://onco.cc/key-papers/paper-napoli-1-nanoliposomal-irinotecan-lancet-2016/), [NAPOLI-3: NALIRIFOX versus gemcitabine plus nab-paclitaxel as first treatment for metastatic pancreatic cancer](https://onco.cc/key-papers/paper-napoli-3-lancet-2023/), [Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and high-risk, early breast cancer](https://onco.cc/key-papers/paper-olympia-overall-survival-ann-oncol-2022/), [PACIFIC: a year of durvalumab after chemoradiotherapy for stage III lung cancer](https://onco.cc/key-papers/paper-pacific-nejm-2017/), [PAOLA-1: olaparib added to bevacizumab maintenance in newly diagnosed ovarian cancer, with benefit confined to HRD-positive tumours](https://onco.cc/key-papers/paper-paola-1-nejm-2019/), [Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis](https://onco.cc/key-papers/paper-cortazar-ctneobc-pcr-pooled-analysis-lancet-2014/), [POLARIX: swapping vincristine for the antibody-drug conjugate polatuzumab vedotin in first-line treatment of diffuse large B-cell lymphoma](https://onco.cc/key-papers/paper-polarix-polatuzumab-rchp-nejm-2022/), [Prasad: most surrogate endpoints in cancer trials correlate poorly with survival](https://onco.cc/key-papers/paper-prasad-surrogate-endpoints-jama-im-2015/), [QuANTUM-First: quizartinib added to intensive chemotherapy and continued as maintenance in newly diagnosed FLT3-ITD AML](https://onco.cc/key-papers/paper-quantum-first-quizartinib-lancet-2023/), [RELATIVITY-047: relatlimab plus nivolumab, the first LAG-3 checkpoint combination, in untreated advanced melanoma](https://onco.cc/key-papers/paper-relativity-047-nejm-2022/), [RUBY: dostarlimab with chemotherapy for advanced or recurrent endometrial cancer](https://onco.cc/key-papers/paper-ruby-nejm-2023/), [Second-line FOLFOX chemotherapy versus active symptom control for advanced biliary tract cancer (ABC-06): a phase 3, open-label, randomised, controlled trial](https://onco.cc/key-papers/paper-abc-06-folfox-second-line-lancet-oncol-2021/), [Sites of distant recurrence and clinical outcomes in patients with metastatic triple-negative breast cancer: high incidence of central nervous system metastases](https://onco.cc/key-papers/paper-lin-tnbc-cns-metastases-dfci-cancer-2008/), [Slamon 2001: adding trastuzumab to chemotherapy for HER2-positive metastatic breast cancer](https://onco.cc/key-papers/paper-slamon-trastuzumab-nejm-2001/), [SOLO-1: two years of olaparib maintenance after first-line chemotherapy for BRCA-mutated ovarian cancer](https://onco.cc/key-papers/paper-solo-1-nejm-2018/), [SPOTLIGHT: zolbetuximab, the first Claudin 18.2 antibody, added to chemotherapy in gastric cancer](https://onco.cc/key-papers/paper-spotlight-lancet-2023/), [STAMPEDE: adding abiraterone to hormone therapy at diagnosis of advanced prostate cancer](https://onco.cc/key-papers/paper-stampede-abiraterone-nejm-2017/), [Stupp 2005: temozolomide added to radiotherapy for newly diagnosed glioblastoma](https://onco.cc/key-papers/paper-stupp-temozolomide-nejm-2005/), [Sustained benefit of adjuvant olaparib in women with germline BRCA1- and BRCA2-associated high-risk HER2-negative early breast cancer: updated results from the OlympiA phase III trial](https://onco.cc/key-papers/paper-olympia-6-year-update-ann-oncol-2026/), [The Multicenter Cancer of Pancreas Screening Study: Impact on Stage and Survival](https://onco.cc/key-papers/paper-dbouk-caps5-stage-survival-jco-2022/), [ToGA (Bang 2010): trastuzumab with chemotherapy for HER2-positive advanced gastric cancer](https://onco.cc/key-papers/paper-toga-trastuzumab-gastric-lancet-2010/), [TROPION-Breast01 China cohort: datopotamab deruxtecan versus chemotherapy in previously treated HR-positive, HER2-negative breast cancer](https://onco.cc/key-papers/paper-tropion-breast01-china-cohort-esmo-open-2026/), [TROPION-Breast01: datopotamab deruxtecan versus chemotherapy in pretreated hormone-receptor-positive breast cancer, and why a PFS win did not translate to survival](https://onco.cc/key-papers/paper-tropion-breast01-jco-2024/), [Tumor Treating Fields With Gemcitabine and Nab-Paclitaxel for Locally Advanced Pancreatic Adenocarcinoma: Randomized, Open-Label, Pivotal Phase III PANOVA-3 Study](https://onco.cc/key-papers/paper-panova-3-ttfields-locally-advanced-pancreatic-jco-2025/), [VIALE-A: venetoclax plus azacitidine for older adults with acute myeloid leukaemia who cannot have intensive chemotherapy](https://onco.cc/key-papers/paper-viale-a-venetoclax-azacitidine-nejm-2020/), [VISION: lutetium-177 PSMA-617 radioligand therapy extends survival in advanced prostate cancer](https://onco.cc/key-papers/paper-vision-nejm-2021/), [ZUMA-7: axi-cel CAR-T instead of salvage chemotherapy and transplant for large B-cell lymphoma that relapses early](https://onco.cc/key-papers/paper-zuma-7-axi-cel-second-line-nejm-2022/)
- roadmaps: [Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem](https://onco.cc/roadmaps/tnbc-roadmap/)
- people: [Michael LeBlanc](https://onco.cc/people/michael-leblanc/)
- bottlenecks: [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/), [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/), [Weak real-world evidence and registries](https://onco.cc/bottlenecks/b-real-world-evidence/)
- ideas: [A RECOVERY-style permanent platform trial of cheap drugs added to cancer care](https://onco.cc/ideas/idea-reg-recovery-style-platform-repurposing/), [A regulatory endpoint for drugs that block spread, not tumours](https://onco.cc/ideas/idea-bio2-antimetastatic-endpoint/), [An independent programme that validates surrogate endpoints, setting by setting](https://onco.cc/ideas/idea-tr1-surrogate-validation-programme/), [Cheap long-term survival follow-up by linking trial participants to registries](https://onco.cc/ideas/idea-tr1-registry-linked-os-followup/), [Deposit trial results as structured data, not just PDFs](https://onco.cc/ideas/idea-data-structured-trial-results-deposit/), [Every patient on an accelerated-approval drug enrolled in a registry until confirmation](https://onco.cc/ideas/idea-data-accelerated-approval-registry-condition/), [Launch prices indexed to the ESMO benefit scale, revisited when survival matures](https://onco.cc/ideas/idea-fund-mcbs-linked-pricing/), [Let MCED trials read out on late-stage incidence, with mortality follow-up mandated](https://onco.cc/ideas/idea-prev-mced-stage-endpoint-surrogate/), [Patent term extension scaled to proven survival gain](https://onco.cc/ideas/idea-fund-value-based-patent-extension/), [Power trials to detect a benefit patients would value, not the smallest detectable one](https://onco.cc/ideas/idea-tr1-power-for-meaningful-benefit/), [Pre-specified crossover-adjusted survival in every trial that allows crossover](https://onco.cc/ideas/idea-tr1-crossover-adjusted-survival-standard/), [Provisional prices for surrogate-endpoint approvals, reset when survival data arrive](https://onco.cc/ideas/idea-reg-provisional-price-until-os/), [Quality-adjusted survival reported in every trial publication and label](https://onco.cc/ideas/idea-moon-quality-adjusted-survival-standard/), [Randomise the next line of treatment before the first one fails](https://onco.cc/ideas/idea-bio1-pre-randomised-sequencing-trials/), [Report time toxicity, the days a treatment consumes, in every trial and decision aid](https://onco.cc/ideas/idea-moon-time-toxicity-reporting/), [Report time toxicity, the days spent in healthcare, as a standard outcome for older patients](https://onco.cc/ideas/idea-acc-time-toxicity-reporting/), [Seamless phase 2/3 with pre-registered go rules as the default for new agents](https://onco.cc/ideas/idea-tr1-seamless-2-3-with-prespecified-go/), [Time to treatment failure and quality of life as co-primary endpoints in non-curative trials](https://onco.cc/ideas/idea-tr1-ttf-and-qol-coprimary/), [Win-ratio endpoints that weigh survival, toxicity and quality of life together](https://onco.cc/ideas/idea-tr1-win-ratio-net-benefit-endpoint/)
- collections: [NICE cancer guidance and technology appraisals (UK)](https://onco.cc/collections/nice-guidance/)
- institutions: [Gemeinsamer Bundesausschuss / IQWiG](https://onco.cc/institutions/g-ba-iqwig/), [ISPOR (The Professional Society for Health Economics and Outcomes Research)](https://onco.cc/institutions/ispor/), [National Institute for Health and Care Excellence](https://onco.cc/institutions/nice/), [Pharmaceutical Benefits Advisory Committee](https://onco.cc/institutions/pbac/)

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