Gene sequencing for lung cancer under-used in Europe

There is plenty of evidence that next-generation sequencing (NGS) for lung cancer can improve patient outcomes and save healthcare systems money, but access across Europe remains “slow and inequitable”, according to a new report.

The study by the Office of Health Economics (OHE) and pharma company Takeda notes that action needs to be taken to correct the disparity in access to NGS, which is recommended for lung cancer patients by healthcare professional bodies, including the European Society for Medical Oncology (ESMO).

NGS provides more information than single-gene testing and can be used to deliver personalised, targeted treatment, but isn’t being offered to the “tens of thousands of people across Europe” who could benefit from it, according to the report. In some cases, targeted therapies are two to three times more effective for non-small cell lung cancer (NSCLC) than chemotherapy.

A key benefit is that NGS allows multiple molecular markers to be evaluated in one shot, whereas single-gene testing may require multiple invasive surgical procedures to obtain tumour tissue.

Barriers to access include lack of funding by health systems, inefficient testing infrastructure, and variation in national guidance, says the report.

In Italy and Spain, for example, there are regional differences which make access to NGS a “postcode lottery” with no reimbursement guidance provided at the national level. In France, reimbursement is limited nationally at 50%, meaning hospitals have to “take a hit of the remaining cost of NGS” and be selective about which patients to put forward for the technology.

England, meanwhile, does recommend NGS for advanced lung cancer, but there is lower uptake than expected, slow turnaround times, poor tissue management, and an overall lack of clinician awareness about NGS.

The report recommends a three-pronged approach to boosting NGS adoption based on the introduction of appropriate pricing and reimbursement mechanisms, standardisation of testing and care pathways, and investment in infrastructure.

“Our research clearly shows the clinical efficacy and technical superiority of next-generation sequencing over alternatives such as PCR and single gene testing,” said Professor Lotte Steuten, deputy chief executive of OHE and a co-author of the report.

“This is the cornerstone of the case for expanding its use in lung cancer. Coupled with potential efficiency savings, and a chance to improve patient outcomes, the case for investing in NGS strengthens.”

Lung cancer is one of the most common cancers in Europe, with around 318,000 cases diagnosed in 2020 and 257,000 lives lost from the disease.

Photo by National Cancer Institute on Unsplash.