Genomic Sequencing of Tumours – Driving all New Developments in Cancer Medicine

What is genomic sequencing?

• Treatment responses and clinical outcomes in cancer patients are highly variable and often hard to predict.
• Cancer, however, is a genetic disease, i.e., caused by changes in DNA/genome that control the way that cells function, grow and divide.
• Genomic sequencing of a tumour provides insights into the cancer’s specific genetic defects (mutations). With this knowledge, doctors can better identify the appropriate drugs, therapies and/or clinical trials for a patient. Genomic sequencing therefore enables precision or personalised cancer medicine. For more on treatment advances, see the third article in this series, Targeted Cancer therapy – Road to Precision Medicine¹.
• Genomic sequencing has also enabled liquid biopsy, the exciting advance in cancer detection and identification via a simple blood test that’s available for some late-stage cancers, but which also holds great promise for wider cancer screening, including multi-cancer testing. For more on liquid biopsy, see the second article in this series, Cancer Diagnostics – Earlier Detection & Impact on Incidence & Mortality².
• Through liquid biopsy and precision medicine, genomic sequencing also gives patients access to effective, personalised cancer care at every step of their treatment plan – not just at the start – which is important since even the same cancer type or subtype can affect patients differently.

Current use and outlook

• Over 75% of US-based oncologists reported using genomic sequencing in 2017 to guide treatment decisions³.
• Currently, however, sequencing is mostly performed for a small subset of advanced cancers, i.e., it is not in widespread clinical use, in part due to the high cost and the long time required for test results.
• Costs range from USD 400 – 1,000. However, as biotechnology companies continue to develop ever faster and cheaper sequencing techniques, cost is expected to fall further over the next few years⁴, approaching the price of a routine check-up.

Rapid progress is underway

• The UK’s NHS became the first national health service in the world to routinely offer genomic medicine from October 1, 2019⁵.
• In Japan, cancer societies have issued consensus clinical practice guidance for next-generation sequencing-based gene panel tests⁶.
• In the US, researchers reported that 37% of 10,000 investigated cancer patients harboured at least one actionable mutation⁷, meaning that the particular cancer could be treated with a targeted cancer drug, mostly derived from new immunotherapies. Genomic sequencing of specific cancers in the US is currently done for approximately 5% of all cancer cases; this is expected to rise.
• Multi-cancer tests, each containing hundreds of actionable mutations, are increasingly coming onto the market – e.g., the FDA recently approved a genetic test panel called FoundationOne^R CDx⁸, with a cost of around USD 5,800. For more on liquid biopsy and multi-cancer tests, please refer to the second article in this series, Cancer Diagnostics – Earlier Detection & Impact on Incidence & Mortality².

Expected impact on Life & Health insurers

• Improving cancer mortality rates. These advances are projected to translate into materially improving mortality rates over the next two decades.
• Genome-based cancer definitions in Life & Health covers. Cancer medicine has until now relied on the paradigm that cancer is an organ- and tissue-specific disease, which is the basis for underwriting and definitions in Critical Illness and Medical Reimbursement covers. This is expected to change to a more genome guided oncology for common mutations which exist among different organ cancers. Ultimately this may mean that a cancer is primarily defined by genetic biomarkers and less by localisation and histology.
• New subdivisions complicate underwriting. Cancers are likely to be subdivided into numerous prognostic groups, complicating underwriting guidelines.
• Increased cost of targeted cancer drugs/therapies. Expenses for targeted cancer drugs/therapies are likely to rise rapidly and significantly above medical inflation⁹.
• Uncertain timeline. The timing and magnitude of all these changes will primarily depend on the clinical access to targeted cancer therapies (availability and cost).

Prediction for the next 10 years

• It is almost certain that within the next decade, almost every cancer patient will be checked by a genome sequencing of their tumour tissue, paving the way to a more personalised and effective cancer therapy.
• Some cancers may become curable, others may experience a less chronic disease, and a third group will not benefit from the developments.

This is the last article in our 4-part series on cancer advances. If you missed any of the previous articles, these contain many interesting insights and discussions, and are all available to view on the PartnerRe website, covering the topics of: global trends in cancer, cancer diagnostics and targeted cancer therapy.

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Bryce Shepherd, Head of Capabilities Development, Life & Health, APAC

This article is for general information, education and discussion purposes only and does not constitute legal or professional advice.