Lung cancer biomarker testing: perspective from Europe

Abstract

A questionnaire on biomarker testing previously used in central European countries was extended and distributed in Western and Central European countries to the pathologists participating at the Pulmonary Pathology Society meeting 26-28 June 2019 in Dubrovnik, Croatia. Each country was represented by one responder. For recent biomarkers the availability and reimbursement of diagnoses of molecular alterations in non-small cell lung carcinoma varies widely between different, also western European, countries. Reimbursement of such assessments varies widely between unavailability and payments by the health care system or even pharmaceutical companies. The support for testing from alternative sources, such as the pharmaceutical industry, is no doubt partly compensating for the lack of public health system support, but it is not a viable or long-term solution. Ideally, a structured access to testing and reimbursement should be the aim in order to provide patients with appropriate therapeutic options. As biomarker enabled therapies deliver a 50% better probability of outcome success, improved and unbiased reimbursement remains a major challenge for the future.

The evolving landscape of biomarker testing for non-small cell lung cancer in Europe

“…impede the use of reflex testing and favouring on-demand testing [69,70]. A further layer of complexity is provided by country differences in reimbursement for liquid biopsy versus tissue testing strategies.…”

Reflex testing in non-small cell lung carcinoma using DNA- and RNA-based next-generation sequencing—a single-center experience

“…This has resulted in a rapid change in NCCN Guidelines, now recommending EGFR molecular testing of all newly diagnosed carcinomas, regardless of the stage (5). National guidelines are in concordance with international guidelines but reflect the local situation regarding drugs and testing availability [for review, see (10,11)]. The 2020 recommendations of the Austrian working group on lung pathology and oncology for the diagnostic workup of NSCLC with a focus on predictive biomarkers recommended reflex testing of all newly diagnosed lung adenocarcinoma for EGFR, ALK, ROS1, KRAS, BRAF, and NTRK 1/2/3 with a recommendation to include also ERBB2, MET and RET, preferably using NGS methods (12).…”

Lung Cancer in Belgium

“…25 Immunohistochemical subtyping is done in a tissue-sparing way, allowing molecular testing in most cases, either on request or as reflex testing. 26 The Belgian health authorities recently issued guidelines on pharmacodiagnostic molecular testing for different tumor types and its reimbursement. 27,28 For lung cancer, an algorithm is proposed with updates every 6 months.…”