Starting in June, certain patients with lung, colorectal, or breast cancer will be eligible for NHI-reimbursed immunotherapy treatments. Approximately 3,400 patients are expected to benefit from this expanded reimbursement policy. According to recent studies, immunotherapy, used alone or in combination with chemotherapy, may be effective in curing advanced lung cancer in patients without genetic mutations. Dr. Tsai Jun-Ming, a specialist in lung cancer treatment, urged the authorities to maintain flexibility in reimbursement policies. He appealed against bundling specific immunotherapies, chemotherapies, or angiogenesis inhibitors into fixed treatment protocols so that doctors can prescribe treatments based on each individual patient's needs and, hence, make the NHI resources more efficient.
There is a wide range of treatment combinations available for advanced-stage lung cancer, including chemotherapy combined with immunotherapy, and in some cases, the addition of angiogenesis inhibitors. Some studies have shown that the combination of chemotherapy and immunotherapy can effectively extend the lives of patients with advanced lung cancer.
However, Dr. Tsai highlighted potential biases in these studies—for instance, they often rely on a fixed combination of a specific immunotherapy with a specific chemotherapy. In actual clinical practice, however, doctors may prefer alternative chemotherapy options to minimize the risk of long-term harm caused by chronic side effects.
Dr. Tsai emphasized that if the NHIA allows for greater flexibility in reimbursement policies and grants doctors the autonomy to tailor prescriptions, doctors will be better positioned to select treatment combinations that align with each patient’s unique health condition. This personalized approach would not only lead to better treatment outcomes but also, as he noted, an “à la carte” treatment is no more costly than a standardized “set menu” treatment.
Dr. Tsai noted that “immunotherapy can be considered a form of targeted therapy.” He explained that when a patient exhibits a high expression level of PD-L1 (the predictive biomarker for immunotherapy efficacy), the treatment is likely to have better outcomes. In such cases, immunotherapy alone may be sufficient. Additionally, some studies have shown that the effectiveness of immunotherapy is influenced by specific gene mutations. For instance, lung cancer patients with STK11 or KEAP1 mutations may have different PD-L1 expression levels, which can negatively impact the response to immunotherapy. For these patients, chemotherapy may be a more effective treatment option.
In international studies on immunotherapy, some research populations are predominantly composed of patients with KRAS gene mutations, whereas EGFR mutations are more commonly seen in Taiwan. When lung cancer patients with EGFR mutations are treated with corresponding targeted therapies, the presence of concurrent KRAS and TP53 mutations can undermine treatment effectiveness—these two mutations together act as “disruptive” resistance genes against EGFR-targeted drugs. However, when KRAS and TP53 mutations occur together, tumors tend to respond more favorably to a combination of immunotherapy, chemotherapy, and angiogenesis inhibitors, showing greater treatment benefits. This illustrates that genetic mutations are closely linked to the effectiveness of immunotherapy. Therefore, conducting next-generation sequencing (NGS) before initiating treatment is a key step in predicting therapeutic outcomes for lung cancer patients.
【2025-05-28 / United Daily】
