How can "genetic testing" help cancer patients? Experts reveal "two major opportunities for use": the most accurate way to snipe cancer cells
“This is a test that affects lives and is worth investing in!” said Li Wanshan, director of the Molecular Pathology Department of the Department of Pathology at Chi Mei Medical Center. “Next-generation gene sequencing” (NGS) is an advanced molecular testing technology. In recent years, cancer patients have become more concerned about The acceptance of testing has increased. As long as the financial situation permits or private medical insurance pays, almost everyone will accept this test. After finding the mutated gene and prescribing the right medicine, it can be said to be a classic model of “precision treatment”.
The key to accurately targeting cancer cells lies in genetic testing! Can it be applied to lung cancer, colorectal cancer, and breast cancer?
In order to enhance the understanding of NGS among cancer patients and the public, the Taiwan Cancer Foundation held the “2023 Precision Cancer Treatment Future: What You Should Know About Defeating Cancer Cells!” patient lectures at National Taiwan University on December 10, inviting 7 heavyweight lecturers. , from the aspects of precision medicine trends, genetic codes for lung and colorectal cancer treatment, and commercial insurance trends, we will accompany cancer friends to make precise attacks.
Vice President Li Gangyuan of Taipei Medical University said that the key to accurately targeting cancer cells lies in genetic testing. Through tumor sections or blood samples, we can find the right cancer friends and provide correct and effective anti-cancer drugs. Since 2000, with the advent of targeted drugs and combined with genetic testing, cancer treatment has entered the era of “precision medicine”, truly personal medicine.
Director Li Wanshan said that among the many cancers, “lung cancer” has the greatest potential for drug use in terms of corresponding genes. There are more than a dozen related genes, many new anti-cancer drugs, and health insurance is gradually covering them. Gynecological cancers such as “breast cancer” and “ovarian cancer” have similar specific mutated genes. There are about 2-3 genes. Corresponding drugs have been released and have remarkable effects. As for “colorectal cancer”, which has been ranked first among the top ten cancers in the past, there are also many tumor-specific genes. Although there are not many corresponding new drugs (2-3 types), it may also be helpful for treatment selection.
Colorectal cancer is difficult to obtain good diagnosis and treatment without genetic testing! It is recommended to fully discuss treatment strategies with your physician
Professor He Jingliang, an authority on bowel cancer treatment in Taiwan and medical director of the Medical Department of Taipei Tzu Chi Hospital, said that high-risk groups can be identified through genetic testing for cancers such as triple-negative breast cancer, ovarian cancer, and metastatic colorectal cancer. Among them, according to the latest announcement from the Taiwan Ministry of Health and Welfare, colorectal cancer ranks second among the top ten cancers occurring in Taiwan in 2021, with a large number of occurrences.
Genetic mutations in colorectal cancer currently have specific corresponding drugs available for treatment; without genetic testing, it may be difficult to obtain the most suitable drug diagnosis and treatment. Professor He Jingliang said that patients with bowel cancer undergo NGS testing. Although there are currently not as many corresponding anti-cancer drugs as lung cancer, it is still recommended to undergo testing under the evaluation of a physician and formulate a treatment strategy.
Especially because colorectal cancer involves multiple genetic mutations, different expressions of tumor-promoting and tumor-suppressing proteins, the physical condition of individual cancer patients, tumor characteristics, location, etc., and the current medical technology continues to work hard in this area, it is recommended that Cancer patients must have full discussions with the medical team to provide the most complete personalized treatment.
Lung cancer ranks first among the top ten cancers for the first time. 70% of lung cancer patients survive longer after being tested
Regarding lung cancer, Vice President Li Gangyuan pointed out that lung cancer has recently topped the list of the top ten cancers in Taiwan for the first time. The number of new cancer patients every year exceeds that of colorectal cancer, reaching more than 16,000, but it is also the most common cancer among all cancers currently. Clinical studies have shown that 70% of lung adenocarcinoma patients can find corresponding anti-cancer drugs after undergoing genetic testing, which can effectively extend their survival.
Vice President Li Gangyuan said that most lung adenocarcinoma patients are caused by “epidermal growth factor receptor gene mutations” (EGFR). Through genetic testing, we can prescribe the right medicine, and 80% of cancer patients have good treatment results after using relevant targeted drugs. Currently, health insurance covers first- to third-generation targeted drugs.
Find out the drug resistance mechanism and possible treatment directions. Experts reveal two major use opportunities for NGS testing
Vice President Li Gangyuan pointed out that NGS has become a powerful anti-cancer tool. According to the testing items, it can be roughly divided into two categories: extensive and general. The former is more expensive and is a comprehensive test that can detect rare gene mutations and can be used as a treatment. Important guidance. As for the general NGS testing items, there are few, mainly for gene testing related to target drugs, such as EGFR, ALK, and MET target drugs. This is the main NGS payment type currently planned by the National Health Insurance.
Vice President Li Gangyuan pointed out that NGS testing takes about 1-2 weeks, and the samples include tumor slices and blood. However, due to limited cancer cell tissue, the amount of samples is often insufficient, which may also affect the treatment rights of cancer patients. . For example, third-generation targeted drugs for lung cancer are expensive, costing hundreds of thousands of yuan a month. Although health insurance provides benefits, the regulations are strict. Genetic testing must be done through tumor biopsies, and only if the results are in line with expectations can you apply for the drug.
However, many patients with advanced lung cancer may have to pay for out-of-pocket medication as their tumor tissue is “incurable”. Vice President Li Gangyuan said that the timing of NGS testing is very important. When cancer is diagnosed, it is recommended to undergo an NGS test to determine the first-line medication. Furthermore, after treatment, drug resistance appears and cancer cells relapse. At this time, extensive NGS can be performed to find out the drug resistance mechanism and possible treatment directions.
Director Li Wanshan holds the same view. She pointed out that testing is most effective after diagnosis and before medication. If sliced tissue can be taken out at this time, the genetic testing report will be an important reference for the doctor’s evaluation. If unfortunately the patient relapses and develops resistance to the target drug, it is recommended to do another extensive NGS test. There is still a chance to find the corresponding drug.
NGS for health insurance benefits is planned to be put on the road next year, which is expected to reduce the financial burden of patients
For some cancer patients, genetic testing is the “beginning of disappointment” because they cannot find corresponding anti-cancer drugs and can only accept traditional chemotherapy. The results are indeed discouraging. The survey shows that what cancer patients care most about is whether the corresponding gene mutation treatment drugs can be found and whether health insurance will cover them. In this regard, Director Li Wanshan said that the speed of research and development of new cancer drugs is beyond imagination, and in time, new drugs may be available.
The National Health Insurance Administration recently held an expert meeting to discuss that 11 types of cancer, including lung cancer and breast cancer, may be included in the first wave of NGS benefits, which could be implemented as soon as the second quarter of next year. In this regard, Chief Medical Officer He Jingliang said that when the new system is launched, it will not only benefit the majority of cancer patients and reduce the financial burden; it can also reduce the cost of health insurance drugs through precise treatment. In addition, patients with clear family histories of breast cancer, ovarian cancer, lung cancer, colorectal cancer, etc. can also be tested to find out whether they have related genetic disease genes so as to respond early.
Vice President Li Gangyuan said that the test is expensive. Taking lung cancer as an example, if it is targeted at lung cancer patients who cannot be operated on, about 5,000 patients will benefit every year. The health insurance will pay for the test, and the key genes can be found and the right medicine can be prescribed. Regarding the development of NGS testing, Director Li Wanshan believes that it has unlimited potential in the future. In addition to precise medication and improving disease-free survival and quality of life of cancer patients, it is currently developing into a tool for accurately monitoring tumor recurrence.
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