Is the EU falling behind in transforming lung cancer care? – POLITICO

This is a paid editorial funded by Takeda Pharmaceuticals International AG.

The value of next-generation sequencing

In February 2021, the European Commission introduced the EU’s Beating Cancer Plan, championing a ‘modern approach’ to turning the tide against cancer.¹ A cornerstone of the plan is next-generation sequencing, a revolutionary technology able to efficiently identify mutations from the simultaneous analysis of hundreds of thousands of genes. Traditionally, hospitals and diagnostic centers have relied on single-gene testing, only able to look for one known mutation at a time. Next-generation sequencing represents a significant step change in the diagnostic landscape, providing a comprehensive understanding of a patient’s specific tumor type.²

This information is vital to guiding diagnosis, prognosis and treatment decisions, particularly for cancers associated with dense numbers of mutations, such as lung cancer. Next-generation sequencing  is the gateway to personalized medicine, treating cancer through tailor-made strategies so patients receive the therapies that work best for them. By minimizing trial-and-error treatments, huge efficiencies can be made, saving governments and overwhelmed health systems time, money, and precious resource.²

The impact that this technology could have across the entire health ecosystem has not gone unnoticed. In addition to being pivotal to the success of the EU’s Beating Cancer Plan, in 2019, ESMO recommended the use of next-generation sequencing for advanced cancers such as lung.³

However, a recent landmark report from the Office of Health Economics (OHE) and Takeda, reveals the concerning reality. In addition to highlighting the compelling case for the use of next-generation sequencing, especially in lung cancer, the report reveals a stark and troubling disparity in uptake across Europe.² Through my work in patient advocacy, I witness firsthand the consequences of these shortcomings, with those most affected being the very people the EU’s Cancer Plan aims to protect — the patients themselves.

So, for a technology with such life-changing potential, why does this level of disparity in access exist across Europe? And what can we, as policymakers and advocates, do to change this?

The barriers to uptake across Europe

The OHE-Takeda report The Case for Expanding Uptake of Next-Generation Sequencing for Lung Cancer in Europe reveals that countries from across Europe face similar challenges, grouped into three categories²:

• Funding and reimbursement: Many countries do not receive comprehensive funding for diagnostics. Patient access to next-generation sequencing is reliant on hospital decisions and their ability to fund cost differences, leading to large national and regional variability in access.
• Testing and reporting standards: Huge variability exists with how cancer biopsies and tissue samples are collected, processed, interpreted and integrated into clinical practice. Education is needed to create a consistency of standards across hospitals, regions and countries.
• Variation in guidance and infrastructure: In most countries, confusion exists around patient referral pathways for advanced diagnostics due to the absence of established infrastructure and accompanying education. Uncertainty often leads to extended wait times for results, delaying the start of treatment, which can be detrimental to patients with aggressive diseases like lung cancer.

A note on limitations with data collection

One significant challenge in addressing unequal access to next-generation sequencing is the lack of comprehensive data on current genetic testing practices — robust and readily-available information on access rates today does not exist. Through my work on Lung Cancer Europe (LuCE)’s Atlas of Access to Lung Cancer Treatment and Biomarker Testing, designed to map out biomarker testing availability, accessibility and reimbursement across Europe, I encountered multiple issues in obtaining accurate and comprehensive information about access to biomarker testing. Despite being based on 2020 data, the EFPIA report on Improving cancer care through broader access to quality biomarker⁴ testing still offers one of the most accurate views of the next-generation sequencing landscape. As time progresses, obtaining a comprehensive view of NGS testing and our starting point is becoming increasingly challenging. To truly gauge the success of our efforts and ensure comprehensive and equitable access to next-generation sequencing, collecting data on genetic testing across Europe must be prioritized.

Actionable steps to promoting change

While these challenges may seem like large hurdles to overcome, each person — from EU policymakers and health leaders to patient advocates and industry — can play a role in advocating for transforming lung cancer care. The OHE—Takeda report highlights six key recommendations that we can start working on now to improve access to testing across the region²:  

1. Inclusion of next-generation sequencing for cancer in national minimal care provision for countries with decentralized health systems;
2. Reimbursement of next-generation sequencing testing according to its value;
3. Adoption of national standards for biopsy sample analysis and reporting;
4. Further development of local clinical guidelines to follow the ESMO 2019 guidelines for lung cancer;
5. The rollout of national initiatives to map patient testing referral pathways;
6. Introduction of national education and awareness programs to ensure all stakeholders within the healthcare system are familiar with next-generation sequencing, guidelines and local testing infrastructure.

From raising awareness of next-generation sequencing as the ticket to personalized medicine and best-practice cancer care, to shaping policy that embeds this technology into cancer plans and local delivery, all stakeholders have a role to play in achieving the ambitions of the EU’s Beating Cancer Plan.¹

Conclusion

The journey to realizing the full potential of next-generation sequencing  for cancer across Europe demands collaboration, urgency and purpose from the entire health care ecosystem. As stressed in the EU’s Beating Cancer Plan¹, the more we understand genetics and the health determinants of cancer drivers, the more we can facilitate access to personalized medicine. Together, we have the opportunity to save precious time and resources, as well as give patients the best chance of survival through treatment tailored to their tumor type. Only then will we truly meet the ambitions of the EU’s Beating Cancer Plan¹ – leaving no stone unturned in the fight against cancer.

Read the full report here: https://www.ohe.org/publications/case-expanding-uptake-ngs-lung-cancer-eu/.

C-ANPROM/EUC/CORP/0056

Resources

1. European Commission. Europe’s Beating Cancer Plan (2021). Available at https://health.ec.europa.eu/system/files/2022-02/eu_cancer-plan_en_0.pdf. . Last accessed: October 2023

2. Sampson et al. (2023). The Case Of Expanding Uptake Of Next-Generation Sequencing For Lung Cancer In Europe. Available at: https://www.ohe.org/publications/case-expanding-uptake-ngs-lung-cancer-eu/. Last accessed: October 2023

3. Mosele, F. et al. (2020). Recommendations for the use of next-generation sequencing (NGS) for patients with metastatic cancers: a report from the ESMO Precision Medicine Working Group. Annals of oncology : official journal of the European Society for Medical Oncology, 31(11), 1491–1505. Available at: https://doi.org/10.1016/j.annonc.2020.07.014. Last accessed: October 2023

4. The European Federation of Pharmaceutical Industries and Associations (2021). Unlocking the potential of precision medicine in Europe – Improving cancer care through broader access to quality biomarker testing. Available at: https://www.efpia.eu/media/589673/biomarker-testing-summary-final-version.pdf. Last accessed October 2023