In battling cancer, there is a secret hero that patients seldom see but plays a crucial role in their survival: the pathologist.
“Diagnosis is our major “hero” work. We select the right patient for the right treatment to improve the chance of treatment success,” explained Professor Tae Jung Kim, a medical doctor and an associate professor of Pathology at The Catholic University of Korea.
Kim was one of the key speakers at a cancer-treatment symposium recently held at the Crowne Plaza Galleria in Quezon City. His talk focused mainly on immunotherapy and the value of biomarker testing for the treatment of lung cancer patients. He also highlighted the significance of government accountability and support in winning the fight against lung cancer, which remains to be the most prevalent cause of cancer-related deaths in the world.
“Identifying the patients’ biomarkers is probably the most important thing that pathologists do in their lives. When you know a patient’s biomarkers, you also know which treatment is right for that patient, and that knowledge strongly contributes to a patient’s survival,” Professor Kim said.
Biomarkers and Immunotherapy
Biomarkers are crucial measurable indicators of the presence or severity of a disease, and its state. Well-known examples of biomarkers include the human chorionic gonadotrophin (hCG) hormone, which usually signals pregnancy, often detected using home pregnancy test kits; and the prostate-specific antigen (PSA), which is used to diagnose prostate cancer.
Biomarker screening is important in the treatment of lung cancer because if a patient is found to have a certain biomarker called PD-L1 – a high expression of which directly correlates to response and overall patient survival – that patient becomes an ideal candidate for immunotherapy, a treatment applied through an immune checkpoint blocker called pembrolizumab.
Immunotherapy accomplishes these by doing away with the use of toxic chemicals to fight cancer cells. Instead, it helps the body’s own immune system to recognize and combat cancer cells. Its effect then is gentler but more effective and durable, as compared to more conventional treatments such as chemotherapy.
“Before 2008, lung cancer was devoid of actual therapy because chemotherapy was not that effective. Then we started targeted therapy and screened for the EGFR (epidermal growth factor receptor)biomarker. Now clinical studies have found that many patients receiving immunotherapy still survive even after the chemo patients had died,” Kim says.
He further adds, “I am a pathologist, so I have no actual contact with the patients, but I have felt and seen the clinicians’ expectations for immunotherapy. I have been involved in biomarker testing for 8 to 9 years. I have never seen this kind of emotional expectation before.”
The Need for Government Support
In South Korea, PD-L1 biomarker screening is covered by the government. “We have a very strong patient-family group, and they have insisted on government insurance for biomarker screening and cancer treatment,” Prof. Kim said.
A possible motivator for government support is economics. Prof. Kim reported that lung cancer patients in South Korea are getting younger and younger. While the disease used to afflict the retired populace, now it hits the active workers in their forties, thirties, and even twenties.
“These patients are, in a financial sense, very important to their family. These patients need time to survive to arrange for their family’s needs. So even if their treatment does not result in a 100 percent cure, if it lengthens their life, the family considers it invaluable.”
Prof. Kim also believes the government owes accountability to these patients. “We do not yet know the actual reason why lung cancer is increasing in our country, but environment pollution can be a factor. So the lung cancer patient is not solely at fault, and the country should care about the patient. If there is a very important biomarker such as PD-L1 for immunotherapy treatment, the government should care about making that biomarker screening accessible for that patient.”
At present, in the Philippines, biomarker screening and immunotherapy treatment are not yet covered by health insurance policies. However, lung cancer patients can apply for an immunotherapy treatment subsidy – up to 55% for qualified applicants – from the Philippine Charity Sweepstakes Office (PCSO).