Cancer treatment is changing and coverage must change with it
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As recently as a decade ago, patients with advanced tumors would come to my office and I could offer little in either treatment or hope. Now I greet patients knowing that, for some, new approaches to fighting cancer may present something close to a cure.

Building on a deeper understanding of tumors and the immune system, targeted treatments usually cause dramatic tumor shrinkage – even at advanced stages. However, that requires knowing the molecular profile of the patient and the tumor. 


From my experience, molecular profiling of lung cancer can help as many as half of patients, yet few get the full recommended panel or know such options are available. Often a limiting factor is lack of insurance coverage for these tests, which can dramatically improve the quality and duration of a patient’s life when matched with corresponding therapies. In an age when these targeted treatments can save lives, reduce symptoms, return patients to their usual occupations and cut long-term costs, testing must keep pace.


The most deadly cancer

Lung cancer is the number one cause of cancer-related death in the United States. According to statistics collected by the U.S. Centers for Disease Control and Prevention (CDC), each year, more people die from lung cancer than colorectal, breast and prostate cancers combined.

In 2016, the American Cancer Society recorded 158,080 American lung cancer deaths and 224,390 new cases. Based on data from the U.S. National Institutes of Health (NIH), about 70 percent of those cases were diagnosed only after the disease had spread, with survival rates often less than a year, from diagnosis to death.

While smoking causes many lung cancers, studies show that more than 60 percent of patients had quit prior to diagnosis, sometimes decades before, and 15 percent never smoked.

That means that every year, lung cancer kills more than 20,000 people who never picked up a cigarette. As a lung oncologist and researcher at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James), patients present with a range of worrying symptoms, from general weakness, pain, cough or even coughing up blood, and most have incurable stage 4 disease. 

But with modern chemotherapies, molecularly targeted therapies and immunologic therapies available today, incurable does not mean untreatable. With targeted therapies, we are seeing some of these stage 4 patients are living upwards of 10 years after their late-stage lung cancer diagnosis. Even better, during this time, many of these patients have returned to a normal quality of life, unburdened by side effects or symptoms. 

With every study, we're learning more about why treatments help some patients and not others — it's a complete revolution in managing lung cancer, and it is entirely dependent upon this molecular profiling that allows matching the right drug to the right patient.

Most cancer patients would benefit from biomarker testing

The National Comprehensive Cancer Network (NCCN) — an alliance of 27 leading cancer centers, including the OSUCCC – James — has included molecular profiling as standard of care in their most current treatment guidelines

We recommend testing at the time of diagnosis, before administering chemotherapy, and before the disease has further spread to optimally benefit from these therapies.

Many doctors only consider targeted drugs as a final option, but the opposite is true. Data from several recent randomized trials show that patient survival is substantially better if patients are first treated with molecularly targeted agents and immunotherapies, even if those tests add time before treatment can begin.

The results of matching treatments to tumor markers are not subtle — when you have a marker and the right drug, you get major tumor shrinkage in most patients, as opposed to about 25 percent with chemo, with longer duration of benefit as well.

You can take someone who is deathly ill and return him or her to a normal quality of life. I can think of many patients of mine, who are non-smokers, exercised regularly, yet developed late-stage lung cancer with significant symptoms and completely unable to work.

When I administer a targeted treatment, these patients often return to a normal quality of life and work.

Test early, cover the cost

At the OSUCCC – James, we're conducting a large-scale effort to show the benefits of up-front biomarker (genetic and immunology) testing in the community. Involving more than 50 partner hospitals, Beating Lung Cancer - in Ohio (BLC-IO) provides biomarker testing, and expert decision support to suggest appropriate targeted treatments, along with smoking cessation help for patients and their families.

Launching soon, BLC-IO has two goals: evaluate the survival and quality-of-life benefits of free up-front advanced gene and immunologic testing with advanced decision support, and helping smokers quit.

Patients receive free testing for more than 300 genes in their cancer specimens, and testing related to PD-L1, which is indicative of immune response to many lung cancers. We expect more than 2,000 newly diagnosed, stage 4 non-small cell lung cancer patients to enroll.

We're trying to identify every new lung cancer patient in this network, and work closely with their oncologists. Most doctors are not experts in genetics, and may not have experience with many clinical trials or latest recommendations.

By sharing information early, we can prove that upfront, advanced, molecular testing improves survival — strong data to support adoption by healthcare providers, insurers paying for the treatments, and regulators enabling the breakthroughs.

There is a high probability that most Americans will get the disease if we live long enough, and it's a simple question to ask what manner of treatment one hopes to receive. Ultimately, biomarker testing matches the right therapy to the right patient and often returns them to work and family, but also avoids using costly therapies in patients unlikely to benefit. This strategy helps us all, and it is time all of us have access to its advances.

David P. Carbone, MD, PhD, is the Barbara J. Bonner Chair in Lung Cancer Research and Director, Thoracic Oncology Center at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.  Dr. Carbone is an expert in the molecular genetics of lung tumors, which includes understanding the specific cells and genetic markers in each patient’s lung cancer and developing treatments and drugs that target specific tumor cells.

The views expressed by contributors are their own and are not the views of The Hill.