Genetic Profiling for Cancer Patients in LMICs

GCI recently hosted a Global Tumor Board Special Session on genetic profiling for metastatic breast cancer, led by Dr. Ben Park from Johns Hopkins and Dr. Aditya Bardia from Massachusetts General Hospital. Genetic profiling is a way to analyze patient tumor samples and analyze on a molecular level the alterations that are unique to different tumors. A new and exciting field, the goal of genetic profiling is to create targeted therapies for cancer patients, based on their unique genetic sequence.

While this technique has great potential for advancing the field of cancer research, its benefits may not be accessible for most cancer patients in low- and middle-income countries (LMICs):

First, genetic sequencing is very expensive, with single tests ranging from $3,000 to $5,000 for a single patient. The final cost increases from there when considering the price of the personalized treatment plan that results from the genetic analysis. This price tag is too high for most, especially for patients who can barely afford standard cancer care.

Second, sequencing requires efficient and streamlined laboratory networks – samples need to be collected and delivered to the lab within hours, and the sequencing itself requires advanced tools and techniques. For many fragmented health systems with few resources, this may be too tall an order.

Finally, even clinical trials – one way many disadvantaged cancer patients are able to receive at least some sort of cancer therapy – may be largely inaccessible for patients in LMICs in this case. The majority of genetic profiling clinical trials are likely to be remain in high-income countries due to the aforementioned barriers in LMICs.

So, is there anything that can be done to share the technological advances of the U.S. and other wealthy nations with the millions of cancer patients in LMICs? Of course, over many years these genetic profiling techniques will get older, become cheaper as newer techniques are developed, and make their way to lower income countries (this happens with many things: TVs, iPhones, and even cancer therapies considered “old school” in the U.S. that have become more mainstream in LMICs.)

Rather than sitting back and waiting for this day to come, Dr. Park said that there a few promising paths that can be considered now:

1. Technology: Currently, “next generation sequencing” (or “NGS”) requires expensive machines and materials. But technology is getting better, faster, and cheaper. Dr. Park imagines that, in the future, we could see “portable kits” for community oncologists to use to sequence quickly, easily, and for low costs. In fact, several companies are continuously updating both their hardware and software – technologies are on the horizon where sequencers may even be plugged into a USB port.
2. Education: Educating community oncologists, both in the U.S. and in LMICs, is another important and inexpensive way to progress the field and start building capacity for when the technology does become available. Lectures, like this one hosted by GCI as part of our Global Tumor Boards, are a good first step, but a more systematic approach is needed to help oncologists understand and interpret genomic tests, information, and how they can help guide therapies.
3. Philanthropy: Philanthropic organizations could support the creation of a “pipeline” whereby patients’ tumor samples can be processed and shipped from LMICs to the U.S., analyzed, and the results sent back to physicians.

However, this last point would also mandate that drugs and trials be available for these patients once they get the results of their sequencing, which Dr. Park says is a much more difficult issue. Personalized therapies are prohibitively expensive and therefore inaccessible to most patients in LMICs (in fact, many personalized therapies are not even covered by insurance providers in the U.S.) So, unless drugs and clinical trials become accessible to these patients – or the pharmaceutical companies bend to allow greater access to high-cost meds for the majority of the world’s population – there would be no utility in making the genetic profiling technology available. Dr. Park concluded, “It has to be an end-to-end solution.”