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Genomic cancer treatment’s benefits should be spread as widely as possible

The Yomiuri ShimbunEvery year, about 1 million people in Japan are diagnosed with cancer. One in two people are expected to develop cancer in their lifetime. The path to new treatments for cancer patients needs to be opened wide.

The nation’s public health insurance system began to cover tests for genomic cancer treatment — a process that uses a patient’s genome, or the complete set of their genetic information — at the start of this month. The testing analyzes a patient’s cancer cells, checks for mutations in at least 100 types of genes in one fell swoop and seeks the most appropriate treatment method.

Cancer occurs when a gene in a cell mutates and the cell begins to multiply unchecked, becoming a malignant tumor. Advancing age is among the causes of these changes. The mutation pattern varies for each patient, so the medicines that will be effective also differ. Pinpointing the drug best suited to the particular condition of an individual patient by using state-of-the-art tests should lead to more efficient treatment.

Many cancer patients suffer side effects from anti-cancer drugs and other aspects of their treatment. Whittling down the options to find the best treatment method should lighten a patient’s physical and mental burden.

For the time being, insurance coverage for these tests will be restricted to patients who have undergone conventional treatments such as radiation therapy or surgery to remove the cancer, but have not seen any improvement in their condition.

Even if a genetic mutation can be identified, there is no guarantee that there will be a drug suited to tackling that mutation. It is estimated that only about 10 percent to 20 percent of people who undergo the testing will actually end up receiving medication for treatment.

Financial concerns

As things stand, 167 large hospitals across the nation can offer genomic treatment testing, and there are few specialist doctors with the expertise to craft treatment plans. To ensure that as many patients as possible can receive the benefits of this system, proper preparations for the testing and treatment processes must be put in place, including the training of more specialist doctors.

This genomic cancer treatment has become a reality against a backdrop of the improved capabilities of devices that swiftly read genetic information and computers that analyze vast amounts of genetic data, and also the fact that such testing can now be done relatively cheaply.

The testing costs about ¥560,000 per person. With testing now covered by insurance, the patient will have to pay a maximum of 30 percent of this fee from their own pocket.

However, there also are concerns that if the number of people being tested increases in the future, insurance expenditures will grow and squeeze the government’s finances for medical insurance. The cost-effectiveness of this system must be constantly reviewed and the expenses involved in the testing kept down.

Results of the tests for genomic cancer treatment also will become data for basic research on cancer. Patients’ test results are to be anonymized, stored in a database at the National Cancer Center and used for research.

Japan noticeably lags the United States and Europe and in this field. It will be essential to accelerate the development of new drugs by using genetic information and data from previous cases. Cooperation among universities, pharmaceutical companies and other entities will be crucial. The government should get behind efforts to get this system up and running.

(From The Yomiuri Shimbun, June 26, 2019)Speech



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