Across 150 included European Phase III lung cancer trials from 2024–2026, overall survival does not appear to be disappearing from endpoint strategy. The stronger signal is endpoint layering: 70.9% of recorded primary endpoint structures were single-primary designs, while 29.1% used dual-primary architecture, often combining faster disease-control readouts with survival anchoring.
The 150-trial evidence base is weighted toward 2024, which contributes 66.0% of included trials. 2025 contributes 25.3%, while 2026 contributes 8.7%, making 2026 useful as an early signal but not as a stand-alone trend base.
The report should be interpreted as a combined 2024–2026 evidence base. The 2026 signal is directionally useful, but the strongest conclusions come from the full 150-trial cohort.
Single-primary endpoint architecture remains the dominant pattern at 70.9%, while dual-primary endpoint architecture accounts for 29.1%. This shows that most late-stage lung cancer trials still concentrate the formal primary endpoint claim, but nearly one-third use a more complex endpoint structure.
The practical takeaway is that endpoint strategy is not uniformly simplified. A 29.1% dual-primary share is large enough that feasibility, statistics, medical writing, and regulatory teams should treat endpoint hierarchy as a core planning risk.
Dual-primary architecture was 23.8% in 2024, 32.0% in 2025, and 58.3% in 2026. The 2026 figure should be read cautiously because the 2026 cohort is smaller, but the direction is consistent with more visible endpoint layering in recent submissions.
The numeric signal is not that OS is being abandoned, but that sponsors may increasingly need two formal efficacy anchors: one to support earlier disease-control interpretation and one to preserve survival credibility.
No clear replacement signal is visible. OS appears across all 3 authorization years and across 3 endpoint positions: primary, co-primary, and secondary. The dataset points to repositioning of OS within a broader endpoint hierarchy rather than removal of OS from late-stage lung cancer strategy.
OS remains visible as a direct primary endpoint strategy.
OS is also paired with endpoints such as PFS in dual-primary designs.
OS frequently supports faster primary endpoints as a secondary survival anchor.
The answer is no: OS is not clearly being replaced. It is being combined with faster endpoints, especially PFS, DFS, EFS, and response-based measures, to balance earlier readout pressure with survival credibility.
The 150-trial dataset shows that European Phase III lung cancer endpoint strategy is not moving toward a simple OS-versus-PFS split. Single-primary endpoint designs still dominate at 70.9%, but the 29.1% dual-primary share is large enough to matter operationally. The 2026 signal, where dual-primary architecture reaches 58.3%, suggests endpoint layering may become more visible in newer submissions.
Overall survival remains an endpoint anchor, but increasingly as part of a hierarchy rather than as the only endpoint story. For clinical development, medical writing, regulatory, and CRO teams, the planning question is not whether OS is present, but how OS is positioned against faster endpoints that drive readout timing and trial competitiveness.