Since the Ministry of Health and Welfare introduced National Health Insurance (NHI) coverage for next-generation sequencing (NGS) in May this year, a total of 639 cases were approved by August. According to the latest data, from May to September, 842 NGS claims were submitted under NHI, reflecting an increase of 203 cases compared to the previous month. Among these, lung cancer accounted for the highest number of claims at 272. Dr. James Chih-Hsin Yang, Director of the National Taiwan University Cancer Center, stated that NGS plays a crucial role in classifying lung cancer and guiding targeted therapies, significantly improving patient survival.
Among the approved NGS claims, lung cancer ranked first with 272 cases, followed by ovarian/fallopian tube/peritoneal cancer (155 cases), prostate cancer (141 cases), breast cancer (107 cases), liver and intrahepatic bile duct cancer (63 cases), pancreatic cancer (16 cases), and thyroid cancer (12 cases). Additionally, 163 claims were for "large panels" (covering over 100 genes), 247 for "small panels" (covering fewer than 100 genes), and 432 for BRCA1/2 gene testing.
Dr. Yang noted that precision medicine has revolutionized cancer treatment. He cited the example of chronic myeloid leukemia (CML), where researchers in the 1960s identified the "Philadelphia chromosome" as the key pathogenic factor. This discovery led to the development of targeted therapies. Compared to interferon treatments, which allowed a five-year survival but no long-term outcomes, targeted therapy has extended the life expectancy of CML patients to over 20 years.
For solid tumors, targeted therapies also prolong survival, but resistance remains a challenge. In lung cancer, for instance, resistance to targeted drugs is a common issue. However, the major genetic mutations associated with lung cancer have been identified, with EGFR being the most prevalent. Others include ALK and EML-4 (each accounting for about 4%), as well as rarer mutations like KRAS, ROS-1, and NTRK. Dr. Yang emphasized that NGS testing is essential for pinpointing these mutations, as they often have corresponding targeted treatments.
NHI does not directly cover NGS tests but provides reimbursement based on the chosen panel. Large panels are reimbursed at 30,000 points, small panels at 20,000 points, and BRCA1/2 testing at 10,000 points. Dr. Yang explained that many patients and doctors aim to gather as much information as possible. For those who can afford it, larger panels are often selected, with out-of-pocket costs ranging from tens of thousands to 100,000 NTD.
Despite its benefits, Dr. Yang highlighted a significant limitation: NHI reimburses NGS testing only once in a patient’s lifetime. Additionally, the testing process takes three to four weeks, which can be agonizing for patients awaiting treatment. Given the high prevalence of EGFR mutations among Taiwanese lung cancer patients, clinical practice often starts with single-gene testing, which delivers results in three to four days. This enables earlier treatment initiation.
For patients who develop resistance to initial treatments, NGS can then be utilized to identify the genetic basis of resistance. This approach helps guide the selection of alternative targeted therapies, providing patients with more options and prolonging survival.
Resource: NGS給付已累計842件、肺癌最多 台大癌醫院長曝有1限制
