New cancer precision medicine guidelines call for increased access to NGS testing

As genetic testing has become an essential tool for diagnosing the pathology of cancer and providing optimal personalized treatment, Korean cancer treatment experts released cancer precision medicine guidelines, stressing the need to increase access to genetic testing.

The Korean Society of Medical Oncology (KSMO) said Tuesday that it has developed domestic cancer precision medicine guidelines in collaboration with the Korean Society of Pathologists. The guidelines emphasize that access to next-generation sequencing (NGS) should be increased in line with the current reality of precision medicine diagnosis and treatment of cancer.

Precision medicine is a new medical paradigm that provides customized prevention, diagnosis, and treatment by integrally analyzing an individual's genetics, living environment, and clinical information. It is already being actively used in cancer treatment.

Since 2017, medical insurance has covered NGS as a selective benefit item, marking the beginning of the era of precision medicine in Korea. That has significantly improved the treatment outcomes of many cancer patients.

As new anticancer drugs are released every year, it gets difficult for doctors and patients to keep up with the latest trends in precision medicine.

KSMO and the Korean Society of Pathologists have published clinical practice recommendations to address these challenges.

“This recommendation presents NGS-based gene panel testing for patients with advanced and metastatic solid tumors,” said Professors Kim Jee-hyun of the Department of Hematology-Oncology at Seoul National University Bundang Hospital (SNUBH) and Professor Kim Wan-seop of the Department of Pathology at Konkuk University Medical Center (KUMC), who led the development of the recommendation. “It aims to provide a way to analyze the cancer genome of patients through NGS and provide optimal personalized treatment based on it.”

Numerous studies have demonstrated that cancer genomic analysis can improve treatment outcomes. Based on this, the recommendation has applied K-CAT, a gene classification system that reflects Korean realities, to 15 cancer types to present a list of key cancer genes that should be tested at the point of care and lead to treatment, they added.

“We recommend NGS-based gene panel testing for the pathologic diagnosis of solid tumors,” the professors said. “We also included descriptions of gene abnormalities essential for cancer diagnosis so clinicians can use them in practice.”

NGS-based gene panel testing is also becoming an essential tool in the pathologic diagnosing solid tumors. For example, bone and soft tissue sarcomas, renal cell carcinoma, and central nervous system tumors often require NGS test results to make an accurate diagnosis. Therefore, this test plays a crucial role not only in the selection of treatments but also in accurate diagnosis.

Nevertheless, the recent increase in co-payments for NGS tests from 50 percent to 80 percent for most cancers, except lung cancer, is a significant obstacle to the spread of precision medicine.

The increase places a significant financial burden on patients, especially those with metastatic and advanced cancers, making it difficult to diagnose and genetically personalize cancer treatment accurately. Currently, it costs about 1.2 million won ($895) to have an NGS test with an 80 percent co-payment. Without NGS testing, patients may miss the opportunity to determine whether their disease is suitable for various molecularly targeted or immuno-oncology drugs and may have fewer opportunities to participate in clinical trials.

Therefore, the two societies recommended expanding health insurance coverage for NGS testing.

“We hope that these recommendations will serve as an important reference for healthcare providers and patients, leading to more accurate diagnosis and optimized treatment,” the two societies said. “Furthermore, we hope they will reemphasize the importance of precision medicine and stimulate public discussion to increase access to NGS testing.”