Lung cancer remains the leading cause of cancer deaths worldwide, but there’s growing hope as survival rates steadily rise. Thanks to early screening and breakthroughs in precision medicine driven by biomarker testing, patients have better odds than ever before.
Despite these medical advancements, Filipino patients still face significant barriers to optimal care. In the country, about half of lung cancer patients have limited access to services that can facilitate better survival and quality of life — such as comprehensive biomarker testing — despite being eligible.
Keep reading to learn more about biomarker testing and the efforts to close the gap in lung cancer care in the country.
What is biomarker testing?
Cancer cells undergo genetic changes that cause them to grow and spread uncontrollably. Healthy cells need more than one change in their DNA to turn cancerous.
Biomarker testing is a test that looks for changes in cancer cells — such as abnormalities in genes, proteins, and other substances — which reveal essential details about cancer.
It can:
– identify if the cancer is likely to grow or spread
– detect if treatment is working
– specify which treatments will or won’t help
– determine cancer risk
– confirm a specific cancer type
– spot signs of cancer recurrence
Who is it for?
Testing for biomarkers isn’t for everyone. While it’s for people with cancer, it’s not yet applicable to all types, but hope is on the horizon as new biomarker tests are being developed all the time.
For those with non-small cell lung cancer (NSCLC), it’s essential to discuss biomarker testing with your doctor. Since these tests guide treatment planning, it’s ideal to have your biomarker results before starting therapy. Here are some questions you could ask your healthcare provider about biomarker testing for lung cancer:
- What are you trying to find with biomarker testing?
- Have I already had any biomarker tests? Which ones?
- Will I need a tissue biopsy, a liquid (blood) biopsy, or both?
- Are there any problems that could happen from the biopsy?
- Who should one turn to if I have any adverse effects after testing, or I’m not feeling well?
- Will the lab test my sample for all known lung cancer biomarkers at the same time (called comprehensive biomarker testing)?
- Will I be tested for these biomarkers: EGFR, ALK, KRAS, ROS1, BRAF V600E, NTRK, MET exon 14 skipping, RET, and PD-L1?
If you have cancer, ask your doctor about whether biomarker testing should be part of your care. If your doctor doesn’t recommend biomarker testing, feel free to ask why. There could be several reasons, such as the test not detecting biomarkers in your cancer that match available treatments. Staying informed allows you to take a more active role in your care and collaborate effectively with your doctor on the next steps.
If you or a loved one is at risk for lung cancer — aged 50 to 80 with a 20-pack-year smoking history, currently smoking, or having quit within the last 15 years — you may benefit from lung cancer screening.
Here are some questions you can ask your doctor about screening:
- I have no symptoms. Why should I get screened now for lung cancer?
- Will the costs be covered by Philhealth or my health insurance?
- What kind of screening methods do you use?
- Is the screening you recommend completely safe? Does it hurt?
Once you have the results of the screening, asking these questions can give you an idea of the next steps to take:
- What are my results and what do they mean?
- What is the next step if my scan is negative (no nodules found)? If my screening is negative, when do I have to get screened again?
- What is the next step if my scan is positive (lung nodules found)?
- How likely is it that my lung nodule is cancer?
- If it is cancer, what are my treatment options?
Role of biomarker testing in lung cancer precision medicine
Every person with cancer has a unique combination of changes in their cancer, resulting in a distinct pattern of biomarkers — also called tumor markers — specific to their case. This means that there’s no one-size-fits-all treatment for cancer.
Biomarker testing is a central part of precision cancer medicine. It involves getting more detailed information about the tumor’s makeup, particularly the DNA changes that support its growth. By pinpointing how your cancer cells grow, doctors can recommend the best treatment decision, prescribing treatments that can work for people whose cancers have specific biomarkers.
These include targeted therapies that precisely “target” cancer cells with these abnormalities. They can:
– interrupt signals that cause cancer cells to grow
– stop signals for blood supply formation
– kill cancer cells
Some tests can also see if you could benefit from immunotherapy, a treatment that helps your body’s immune system fight cancer.
Unlike traditional treatments like chemotherapy and radiation, which affect all cells in the body, targeted therapy focuses only on cancer cells with specific biomarkers. This approach spares more healthy cells, leading to fewer side effects.
Knowing your treatment options can help you make more informed decisions about your care. Here’s a list of questions you can ask your health provider about available lung cancer treatments:
- Which treatment or combination of treatments would you recommend for me and why? Are there other treatment options available, such as clinical trials?
- When will the treatment start? Is there time to wait and see, and time to consider my options?
- What are the potential side effects of the recommended treatments? How might they affect my quality of life? And what can we do to manage them?
- To whom should I speak if I have further questions during the treatment or if I experience something alarming?
- How do I take my treatment and how often? How will I know if it is still working?
If your doctor recommends joining a clinical trial, here are some helpful questions:
- Can I do a clinical trial and standard treatment simultaneously?
- What is the goal of each phase of a clinical trial? How do I know which phase to join the clinical trial in?
- What are the advantages and disadvantages of joining a clinical trial versus taking standard treatment or chemotherapy?
- If I begin to have side effects from a clinical trial treatment, can I stop it and go on a different treatment?
Biomarker testing in the Philippines: Current state and updates
While these innovative therapeutics hold much promise, they aren’t readily available and accessible in many countries like the Philippines. This hinders them from getting a more informed diagnosis for better treatment decisions.
Some of the barriers preventing Filipino patients from accessing biomarker-driven cancer treatment include:
– Logistical challenges: Diagnostic procedures are often physically inaccessible or unavailable.
– Complex testing processes: Testing is often done sequentially, making it time-consuming and complicated.
– Lack of funding: High costs for diagnostics and treatments limit access.
– Low awareness: Patients may be unaware of innovative testing and treatment options.
Addressing these barriers can help make precision medicine an accessible reality.
Driving access through multi-stakeholder collaboration
To drive equitable access to lung cancer testing and innovative treatments in the country, a campaign, “Hit the Mark,” was launched last March 21, 2024.
The initiative is led by patient groups and advocates, medical societies, providers, and healthcare companies like laboratories, who believe every Filipino deserves to get the “right testing for the right patient, at the right time,” the mantra of precision medicine.
Driving the momentum is the global collaborative multi-stakeholder initiative called From Testing to Targeted Treatments (FT3) program, which aims to make personalized medicine accessible for all patients who can benefit from it. After successful pilots in Hungary and Spain, FT3 is now focusing on expanding these efforts in the Philippines.
Addressing barriers to cancer care
Efforts are currently underway to overcome barriers to precision medicine access in the country, ensuring that more Filipinos can benefit from advanced diagnostic and treatment options.
To overcome logistical challenges and simplify the testing process, Hi-Precision Diagnostics (HPD) now offers nationwide coverage for lung panel testing. They have also introduced a unified test request form, streamlining the process and reducing the back-and-forth typically associated with diagnostic testing. This approach speeds up turnaround times and makes diagnostic procedures more accessible and efficient for patients across the country.
The medical diagnostic center has combined three key biomarkers — PD-L1, EGFR, and ALK — into a single lung panel test, allowing simultaneous rather than sequential testing. Having a single lung panel test reveals diagnoses faster, saving time, money, and effort. Most importantly, unifying lung panel tests ensures that patients receive appropriate treatment as soon as possible.
Financial constraints is a serious barrier to care among Filipinos. To help address this, HPD provides options for tests to be subsidized upon consultation with a doctor, available across all 65 branches of Hi-Precision Diagnostics nationwide.
Other initiatives policymakers propose to overcome financial barriers in the country includes ensuring that the Cancer Assistance Fund (CAF), which provides accessible diagnostic and laboratory services, particularly for socioeconomically disadvantaged patients, is adequately funded. Additionally, the full implementation of the National Integrated Cancer Control Act (NICCA) can help provide medical and financial assistance to cancer patients.
To increase people’s awareness of precision medicine, including biomarker testing and innovative treatment for lung cancer, partnerships with local groups like the New Vois Association of the Philippines are being pursued.
By raising awareness about biomarker testing, we can ensure better, more personalized treatments — and more hopeful tomorrows for Filipino lung cancer patients.
PH-NON-01052
