Does lung adenocarcinoma have "tumor mutations" that determine the patient's fate? Doctors call for: First-line "immunization + chemotherapy" should speed up health insurance benefits
Patients with “lung adenocarcinoma” without tumor mutation become health care orphans! The treatment gap may become a bottomless abyss
Cancer has been the leading cause of death in Taiwan for 41 consecutive years, and lung cancer is currently the “triple crown” of cancer in Taiwan: the number of incidences, the number of deaths, and the proportion of late-stage cases all rank first. Although the Taiwan Ministry of Health and Welfare has promoted publicly funded low-dose computed tomography (LDCT) screening in July 2022, more than half of Taiwan’s lung cancer patients are diagnosed at an advanced stage, and lung adenocarcinoma accounts for the majority.
However, patients with lung adenocarcinoma and those with “tumor gene mutations” are expected to be the first line to use targeted drugs provided by the National Health Insurance; while for patients without tumor gene mutations, the current treatment covered by the National Health Insurance still remains at “traditional chemotherapy.” It can be said that we have fallen into the dilemma of “health care orphans”. Relevant units and experts have unanimously called for health insurance to be in line with international treatment guidelines as soon as possible to prevent the biggest treatment gap for advanced lung cancer from becoming a bottomless abyss.
In order to call on the government to pay attention to the treatment needs of vulnerable lung adenocarcinoma patients, the Taiwan Cancer Foundation and the Taiwan Society of Thoracic and Intensive Care Medicine, together with Huang Junyao, chief physician of the Department of Chest Medicine at Taipei Tzu Chi Hospital, and Chen Baozhong, a distinguished professor at the School of Public Health of National Taiwan University, called for the creation of a healthy Taiwan , implement medical equality, prioritize the fight against lung cancer and end the tragedy of lung adenocarcinoma treatment for vulnerable people who have not been taken care of by health insurance.
The survival period is doubled and the risk of death is reduced by 40%! Doctor: Payment for first-line immunotherapy combined with chemotherapy should be accelerated
Dr. Chen Yumin, chairman of the Taiwan Society of Thoracic and Intensive Care Medicine, said that about 70% of lung cancer patients are lung adenocarcinomas, and the majority of them are “tumor gene mutations”. The first-line targeted treatment resources provided by health insurance are relatively abundant; However, more than 30% of patients do not have tumor gene mutations. Immunotherapy combined with chemotherapy is the first choice in clinical treatment guidelines in Taiwan and abroad. However, the first-line treatment covered by health insurance still remains traditional chemotherapy, which may become the largest treatment gap for advanced lung cancer at present.
Mr. Zhang, 50, was diagnosed with stage IV lung adenocarcinoma more than four years ago. After genetic testing, it was determined that it was a vulnerable lung adenocarcinoma that did not have tumor gene mutations and was not suitable for targeted drugs. He was in his middle age and had the responsibility to support his family. He thought that if he fell ill due to illness, his family’s financial resources would be cut off. Therefore, Mr. Zhang decided to follow the doctor’s advice and use immunotherapy combined with chemotherapy to fight cancer at his own expense. So far, he has survived for more than 55 years without disease progression. months.
Another 61-year-old Ms. Zhuo was diagnosed with advanced lung adenocarcinoma about 6 years ago. She also had no tumor gene mutation. After evaluation by a doctor, she chose to use immunotherapy combined with chemotherapy at her own expense to save her life. She has survived for more than 68 months. .
Dr. Chen Yumin said that large-scale clinical studies have confirmed that patients with advanced lung adenocarcinoma without tumor gene abnormalities who use immune drugs combined with chemotherapy in the first line have a median survival of 22 months compared with chemotherapy alone. Compared with the latter’s 10.6 months, the median survival time is doubled, and the risk of death can be reduced by 40%. “Last year, National Health Insurance paid for first-line immune drugs combined with chemotherapy for lung squamous cell carcinoma and small cell lung cancer. Lung adenocarcinoma is the top priority for lung cancer. Payment should be accelerated to catch up with international trends!”
Lung cancer among the workforce has increased by 90% in the past decade! The fate of tumors with or without mutations is vastly different
Tsai Li-juan, deputy executive director of the Taiwan Cancer Foundation, pointed out that statistics show that more than half of lung cancer patients in Taiwan are diagnosed at an advanced stage. In the past decade, the number of people suffering from lung cancer has increased by 90% among the labor force group aged 20-60, accounting for 90% of the total. One-third of lung cancer patients live an average of 9.7 years less than the average person. Therefore, improving the treatment of advanced lung cancer is crucial to stabilizing family economic support and social stability.
According to the recommendations of the five major medical associations in Taiwan and the NCCN Guideline, the first-line treatment is immune drugs combined with chemotherapy, but the health insurance has not yet covered it. In other words, the presence or absence of tumor gene mutations will determine the fate of patients with advanced lung adenocarcinoma. . “Equity should be considered in the allocation of health care treatment resources, so that disadvantaged lung adenocarcinoma patients have the opportunity to be treated!”
Dr. Huang Junyao said frankly that for lung adenocarcinoma with tumor gene mutations, targeted therapy is recommended as the first line. For patients without tumor gene mutations, immunological drugs or immunological drugs combined with chemotherapy are recommended as the first line. If we use this as a standard and compare the coverage rate of current health insurance benefit standards, we will find that 72% of lung adenocarcinomas have tumor gene mutations, and health insurance benefits are relatively complete in line with international standard treatments.
On the other hand, for lung adenocarcinoma without tumor gene mutation, the coverage rate of health insurance benefits is only 17%. For the same lung adenocarcinoma, the gap in health insurance treatment resources is as high as 4 times. Dr. Chen Yumin said that so far nearly a thousand early-stage lung cancer patients have been identified through publicly funded LDCT screening. This policy should be affirmed, but according to the latest statistics, there are nearly 17,000 new cases of lung cancer in a year, and the number of people suffering from lung cancer is expected to continue to rise. , the number of early-stage lung cancers detected by LDCT screening only accounts for about 5% of the overall new number of lung cancers, and it is difficult to reverse the current situation of more than half of late-stage lung cancers in the short term.
Up to 76% of lung adenocarcinoma patients do not smoke? Is excessive PM2.5 a major culprit of lung adenocarcinoma?
“Early screening for lung cancer and improved late-stage treatment policies should be given equal emphasis to effectively combat lung cancer.” Dr. Chen Yumin said that according to statistics, up to 76% of lung adenocarcinoma patients in Taiwan are non-smokers, and lung adenocarcinoma is more common in women who do not smoke, especially in Asia. . Distinguished Professor Chen Baozhong also pointed out that air pollution PM2.5 derived from economic development is one of the culprits of lung cancer; local research has confirmed that PM2.5 concentration is directly proportional to the incidence of lung cancer.
Distinguished Professor Chen Baozhong added that local research found that taking non-smoking female patients with advanced lung adenocarcinoma as an example, under the same air pollution conditions, the five-year survival rate of those with tumor gene mutations was higher than that of those without tumor gene mutations. And the gap can reach 3 times, which shows that the former has a better prognosis due to the relatively complete target treatment paid by the national insurance, while the latter has a direct impact on the survival rate due to the insufficient application of immune drugs by the national insurance.
The first-line immune drugs combined with chemotherapy are used for the treatment of advanced lung adenocarcinoma without tumor gene mutations. The efficacy has been fully verified by science. It is now the international standard treatment and is covered by the health insurance of many advanced countries such as Japan, South Korea, Europe and the United States. , compared with Taiwan, which still relies on traditional chemotherapy, resulting in a huge gap. Dr. Huang Junyao said that Taiwan has an enviable health insurance system, and the treatment of lung adenocarcinoma cannot lag behind, and should speed up to catch up with advanced countries.
Since Taiwan promoted publicly funded LDCT screening, it has seen a lot of results, but it has also seen problems with treatment. It is urged that in the future, vulnerable lung adenocarcinoma should also be included in the protection. In the past, people thought that stage four lung adenocarcinoma was equivalent to a “death sentence.” Now there is a chance of recovery through treatment. This is a great encouragement to the patients’ families. They also hope that Taiwan’s health insurance can follow international guidelines and include cancer immunotherapy drugs. Combined chemotherapy is included in the benefit.
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