BREATHING IN A NEW ERA
A COMPARATIVE ANALYSIS OF LUNG CANCER POLICIES ACROSS EUROPE
The two common surgical procedures for lung cancer are lobectomy (the removal of an entire lung
lobe) and wedge resection (removing only a portion of the lobe). Living without a lobe or even with
only one lung is possible and does not usually impact life expectancy. Chemotherapy is drug treatment
by agents that are systemic, not specific to a particular type of cancer: platinum-based chemotherapy
is the recommended treatment for many lung cancer patients.^56 Radiotherapy uses radiation to
kill cancer cells. We found significant variability in access to radiotherapy between countries. Most
counties experience a demand for radiotherapy that exceeds the supply of radiologists and machinery
to deliver the treatment (Table 3).57, 58 Variation in supply was also found within some countries. For
example, participants reported that in the UK access to advanced radiotherapy techniques varies
regionally.
Surgery, chemotherapy and radiotherapy have long been the backbone of cancer therapies.
Over the past decade, however, new therapy options have emerged, including targeted therapy and
immunotherapy. Targeted therapy consists of medications that specifically target certain cellular
changes; because they are more focussed than systemic chemotherapy drugs, they often have less
severe side effects. They are typically used for patients with advanced lung cancer either on their own
or in combination with chemotherapy.^59
Immunotherapy leverages the body ’s own immune system to fight cancer.^59 The medication
targets a protein receptor on a type of white blood cell called T-cells, also known as T-lymphocytes.^60
This process enables the T-cells to recognise cancer cells and kill them.^60 As with targeted therapy,
it is possible to use immunotherapy alone or in combination with chemotherapy. In order to get an
estimate of availability of targeted and immunotherapy drugs, we looked at the targeted therapies
aftinib, crizotinib, erlotinib and gefitinib, and the immunotherapy drug pembrolizumab. Each was
approved and reimbursed in our 11 countries.Tumour testing: a necessary but often overlooked first step
The rise of targeted therapy and immunotherapy means that testing of tumours has become
increasingly important. Testing to identify specific ‘biomarkers’ allows clinicians to identify which
drug is the best match for the patient’s cancer. There are four tests commonly used in lung cancer:
anaplastic lymphoma kinase (ALK), epidermal growth factor receptor (EGFR), ROS proto-oncogene 1,
receptor tyrosine kinase (ROS1) and programmed death ligand 1 (PD-L1). Choosing the right therapy for
a specific patient increases the likelihood that he or she will respond to treatment.
Requirements for biomarker testing vary widely. In France, for example, over 90% of biomarker
testing is done for first line immunotherapy treatment but this is not required for all second line
immunotherapy treatments. The cost of biomarker testing is borne by the hospital from an annual
budgetary allowance from the state; once that allowance has been depleted, the remaining costs of
the tests must be funded from elsewhere in the hospital’s budget. In other countries biomarker testing
is not reimbursed at all by the public health system, or subject to an annual limit. This can result in
situations where an (expensive) innovative treatment is reimbursed but the ( inexpensive) diagnostic
test is not. One way of avoiding this conundrum can be found in Belgium, where new legislation
means that testing for some—though not all—biomarkers will be coupled with the treatment for
reimbursement purposes.^61