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Oncology experts shed light on progress of genetic testing and targeted therapies in lung cancer.
Lung cancer is the second most common type of cancer and by far the leading cause of cancer death among both men and women, according to the American Cancer Society. The group estimates that about 234,030 new cases of lung cancer will be diagnosed and 154,050 people with die from lung cancer in 2018.
A Milliman study, published in 2017, researched the costs to cancer patients and their health plans for three types of cancers: breast, colorectal, and lung, from 2011 to 2014. Patients who were diagnosed with lung cancer had an average total healthcare cost of $282,147 and patient out-of-pocket cost of $11,180 over the 47-month study period.
“These costs are largely driven by diagnosis and surgery, but the costs continue for months or years after the initial diagnosis,” says Professor Hilary Thomas, a U.K.-based KPMG partner and chief medical advisor of the firm’s Global Health Center of Excellence. “The problem is that the current standard of therapy for non-small-cell lung cancer (NSCLC) provides a median survival rate of 16 to 24 months and a five-year survival rate of 25%.”
According to Kevin Kovitz, MD, MBA, pulmonologist for the University of Illinois at Chicago Hospital and the Chicago Chest Center, “Healthcare executives need to understand the resources needed to both diagnose and treat and decide what is best for their institution to offer versus refer out.”
• Do you offer a lung cancer screening program? “Medicare and commercial insurance cover screening in those who meet defined criteria but proper resources and provider education are required,” Kovitz says.
• Do you offer an advanced diagnostic procedures and imaging[TW1] ?
• Do you offer robotic surgery[TW2] ?
One of the most notable developments in lung cancer treatment is the advancement of genetic testing and targeted therapies, according to experts.
“The standard treatment for advanced NSCLC has historically been a combination of cytotoxic chemotherapy and radiation, however the survival rates were low and the costs and side effects were considerable,” says Megan Czarniecki, vice president of Genetic Analyst Services at InformedDNA. “With the increased understanding of specific genetic changes and the underlying mechanism of disease progression, targeted therapies have led to improved outcomes.”
One of the first examples of targeted therapy in practice was the 2011 American Society of Clinical Oncology’s opinion that patients whose tumors carry the EGFR gene changes, should have an EGFR tyrosine kinase inhibitor (TKI) as a first-line therapy and skip the traditional course of cytotoxic chemotherapy and radiation, according to Czarniecki.
“This approach led to improved tumor response and reduced toxicity for patients,” says Czarniecki. “After this watershed shift in paradigm, additional therapies were initiated for patients with mutations in other genes such as ALK, KRAS, BRAF, and ROS1.”
Thomas agrees. “Therapies are becoming much better targeted and tolerated than past treatments,” she says. “There are still debilitating side effects from cancer treatment, but the therapies are far better tolerated than they used to be; radiation treatment is also much more precise than in the past and will continue to improve.”
Personalized medicine has a future in standard therapeutic decision-making in oncology, including lung cancer.
“Oncology has traditionally been toward the forefront of using personalized medicine. Many of these treatment paths are driven by biomarkers, which are increasingly connected with the indication for a particular drug,” says Thomas.
“From a molecular genetics perspective for NSCLC, molecular medicine has already shown improvements with the use of specific targets to guide management and improve outcomes,” says Czarniecki. “The overall trend in lung cancer is to pursue multigene panels to help further this effort.”
There is also a movement toward earlier diagnosis, minimally invasive treatments, and hopefully longer survivals, in lung cancer, according to Kovitz.
Lung cancer screening places a large role in early diagnosis and longer survival rates. In fact, the National Lung Screening Trial (NLST) showed a 20% lung cancer mortality reduction and a 7% all-cause mortality reduction in the targeted population.
“The advent of combinations of targeted therapies that ‘supercharge’ the immune system makes oncology a very exciting frontier,” says Thomas.
According to the 2015 Medicines in Development Report from PhRMA, there are 123 medicines in various stages of development for lung cancer. Additionally, many existing treatments for cancer are seeking approval for additional indications.
Erin Bastick, PharmD, RPh, is staff pharmacist at Southwest General Health Center, Middleburg Heights, Ohio.