Building Equitable Access For Patients With Lung Cancer

The cancer research landscape looked vastly different when I began my career almost 15 years ago.

As just one example, when I graduated from medical school, tyrosine kinase inhibitors (TKIs) were approved for the treatment of non-small cell lung cancer (NSCLC), but the fact that specific genetic mutations drove activity was not yet established. TKIs were approved for patients whose disease had progressed after chemotherapy regardless of mutation status. Compare that to today, where there are approved targeted therapies based upon eight different molecular variants of NSCLC.

The field of oncology research is inspiring because it’s ever evolving. Year after year, innovation and ingenuity breed new treatments for patients – and of course one day, we all hope to eradicate cancer for good.

I entered the field of cancer research as a thoracic oncologist and eventually came to work for Janssen because I wanted to be part of this meaningful work and help people when they need it most. I believe when we’re backed by a clear plan, strong data and effective communication, physicians can, in a single moment, profoundly alter the trajectory of a patient’s life.

As we approach November and Lung Cancer Awareness Month, though, I am reminded of how much further we must go to ensure the highest standards of cancer care, intervention and treatment are accessible to all.

This is especially true when it comes to lung cancer, one of the most stigmatized cancers because of its association with smoking. Perhaps as a result, lung cancer is drastically underfunded compared to the impact it has on society. The truth is lung cancer is not a disease that only affects people who have smoked cigarettes. Anyone with lungs can develop lung cancer – it doesn’t discriminate. While there have been significant advances in treatment over the last decade, lung cancer remains the leading cause of cancer death for both men and women worldwide.

In my view, equitable access to cancer treatment starts with equitable access to information – for physicians and patients alike. Genetic testing using next-generation sequencing (NGS) should be the standard of care for molecular testing in NSCLC. Why? Because it is significantly more efficient than traditional single-gene tests such as polymerase chain reaction (PCR) or Fluorescence In Situ Hydridization (FISH) in identifying genetic mutations in patients with lung cancer.

Testing techniques like NGS that can detect a broad range of mutations and the careful examination of biomarker test results can be instrumental in helping healthcare professionals provide targeted treatment options for patients. In contrast, single gene testing such as PCR or FISH can only look in one gene region at a time. 

With the availability of so many revolutionary targeted therapies in NSCLC, looking at each gene one at a time is inefficient in terms of tissue, time, and cost. NGS and single-gene testing both often require a tumor biopsy to look for certain genetic markers. With single-gene testing, that small bit of tumor results in little information and precious time wasted for patients – time they don’t have to spare. With NGS testing, that same small bit of tumor provides an enormous amount of information. With one test you get hundreds of gene results. That is a huge boon.

Beyond this, in patients with NSCLC with certain genetic alterations, data indicate that PCR kits may miss a large percentage of targetable mutations. If the correct mutation is not identified, whether it is due to less breadth of testing or inaccurate test results, the patient may not get the correct treatment.

We know that targeted therapies have changed the treatment of lung cancer - this is an undeniable fact. Despite educational and financial implications, there are clear steps we can take now to expand access to and understanding of NGS testing:

• Collaborating with the diagnostic testing industry to ensure that NGS reports are clear and understandable to physicians and patients. Patients are often their own best advocates. By helping to make NGS test results more digestible, we’re helping patients and healthcare practitioners more effectively address this deadly disease, together.
• Ensuring simpler processes for financial reimbursement. Reimbursement barriers exist within the US and around the world, but no patient should be stuck with a large bill that could hinder them from receiving the care they need.
• Accelerating global access to NGS testing. NGS testing is still inaccessible to some on a global scale. To address this, the pharmaceutical industry should build on expanding collaborative efforts and work with local and global testing companies to implement systems that broaden patient access to precision diagnostics.

We are on the precipice of a revolution in how we treat lung cancer. In order to find the best tailored approach for people with lung cancer, we must develop a comprehensive treatment ecosystem. At Janssen and Johnson & Johnson, we are leading the charge to improve access to diagnosis and treatment for all and, ultimately, eliminate lung cancer around the globe.

November 1, 2022