Make Genomic Medicine Accessible to More Cancer Patients

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"Genomic medicine" is becoming more widespread in Japan. It takes the genetic mutations that cause cancer, investigates them, and recommends appropriate therapy for each patient.

Cancer gene panel testing, the starting point for this kind of treatment, became covered by insurance in June 2019. By FY2024, 280 medical institutions throughout Japan had performed approximately 100,000 such tests, according to the National Cancer Center.

The spread of panel testing has the potential to revolutionize cancer treatment. Currently, the basic approach follows evidence-based "standard treatment" of surgery, radiation, chemotherapy with anticancer drugs, and other therapies. Patients eligible to take a panel test are limited to those who have completed or are scheduled to complete this standard treatment.

How It Works

Evidence indicates that, for some patients, panel testing can identify additional treatment options beyond standard treatment. Nevertheless, for more patients to benefit from genomic medicine, it will be necessary to make it easier for them to participate in clinical trials at medical institutions equipped with the knowledge and necessary experience.

So far, individuals who have undergone panel testing were predominantly patients with few treatment options available. Those include patients with pancreatic, ovarian, or head and neck cancers.

For example, if the test results show that a pancreatic cancer patient has a mutation typical of breast cancer, a drug used to treat breast cancer may become an option.

*National Cancer Center Hospital in Tokyo's Chuo Ward.*

Overcoming the Insurance Gap

One problem is that even when options are discovered, they do not necessarily translate into treatment. Medication recommendations were identified for about half of the patients tested. However, survey results show that less than 10% of these patients actually received the medication in question.

The reason is that the drugs indicated as potentially helpful through panel tests are not necessarily covered by health insurance. For example, the drugs in question may not yet have been approved for use in Japan. And even if they are available, they may not be suitable for the individual patient's condition.

In such cases, the most effective option may be for the patient to participate in clinical trials conducted by pharmaceutical companies or doctors. However, these trials are usually conducted at large hospitals in urban areas. Participation imposes a heavy physical and financial burden on patients living in rural Japan.

Accessibility Through Collaboration

There is an urgent need to make clinical trial information easy to understand and widely available. With that, the number of clinical trials conducted remotely through collaboration between medical institutions could be increased. The goal is to link those institutions to provide actual treatment options for patients.

Making it easier for patients to participate in clinical trials would also facilitate new drug development by pharmaceutical companies.

In turn, this would help eliminate the problem of "drug loss," referring to drugs that have been approved in Europe and the United States, but their equivalents are not yet available in Japan. In many cases, their development in Japan has not yet even begun.

Once the therapeutic benefits of panel testing are acknowledged, it should also be considered for use at earlier stages of illness. The promising future of cancer genomic medicine is certainly something to get excited about.

Author: Editorial Board, The Sankei Shimbun

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