Precision Medicine Forum Gathers Experts to Pioneer Taiwan’s Personalized Cancer Care

Malignant tumors have consistently ranked as the leading cause of death in Taiwan for 40 straight years. In 2020, for example, the cancer incidence rate in Taiwan reached 311.3 per 100,000 population, with specific types like breast and colorectal cancers increasing among younger populations. This trend underscores the urgent need for precise and personalized cancer care, aiming to enable early detection and optimize treatment outcomes.

Organized by the Taiwan Oncology Society and co-hosted by entities like ACT Genomics, the “2023 Advanced Precision Cancer Medicine Forum” was held on August 27 at Le Meridien Taipei. The event brought together hundreds of doctors, scholars, and experts to explore new opportunities for the development of precision cancer medicine, through clinical case studies, key points of testing principles, and relevant healthcare policies. 

Furthermore, the recent announcement by the National Health Insurance Administration, Ministry of Health and Welfare (MOHW), in July that next-generation sequencing (NGS) for precision cancer treatment would be covered by health insurance starting in 2024 heightened the forum’s focus on pertinent policy issues.

Related article: APCM 2022: Precision Medicine Is Opening Up a New Prospect of Cancer Therapy 

Is Taiwan Ready for Precision Medicine?

The morning session primarily delved into Taiwan’s precision medicine development and its future from a policy perspective. It also highlighted the emergence of the “Molecular Tumor Board (MTB)” concept in recent years. Dr. Yang, Pan-Chyr, a renowned lung cancer researcher, kicked off the session with insights into the remarkable improvements in patient survival rates achieved through genetic testing and the identification of driver genes in tumors. Coupled with targeted drugs, these studies have led to enhanced outcomes, even in notoriously challenging cancers like pancreatic cancer.

Dr. Yang underscored how various countries are actively nurturing the precision health industry, combining biomedical science, research and development, information technology, and artificial intelligence (AI). These efforts are strengthening the collection, integration, and analysis of public health data and enhancing healthcare policies through disease prevention, early diagnosis, and personalized treatment. Notable examples from the United States, Japan, and Singapore were cited to illustrate how gene sequencing data, electronic healthcare records, and big data analysis can drive precision health development.

Dr. Yang also shared that Taiwan, recognizing precision health as one of its six core strategic industries, has embarked on the “Taiwan Precision Medicine Initiative (TPMI).” Collaborating with 16 healthcare systems across Taiwan, this initiative aims to collect genetic data from approximately one million individuals. It seeks to establish a risk assessment model for common diseases, employing genome-wide association studies (GWAS), AI and big data.

Yet, Yang also stressed that TPMI faces practical challenges, including infrastructure innovation, medical data consolidation, international standards compliance, regulatory flexibility, and the utilization of AI and telemedicine. To keep pace with the international community and transition from precision medicine to precision health, Taiwan must seize opportunities in research and development, regulatory adjustments, incentive creation, and talent cultivation.

Dr. Yang Pan-Chyr of Academia Sinica shared his insights on the development of personalized cancer care in Taiwan.

Taiwan’s Precision Medicine and Bio-Data Integration: Progress and Prospects

Prof. Chen Li-Tzong from Kaohsiung Medical University stressed the importance of precision cancer care not only for better treatment options and prolonged survival but also for lowering healthcare costs. As genetic testing technologies advance, new drug treatments emerge, potentially leading to increased medical costs and healthcare disparities. Taiwan must expedite healthcare insurance coverage for cancer genetic testing to align with neighboring Asian countries.

While lung cancer has been a model case for precision medicine, Prof. Chen predicted that biliary tract cancer (BTC) may also become a focus in the future. Although BTC has a poor prognosis among GI cancers, some patients carry a gene alteration (FGFR2 fusion) suitable for targeted therapy. Genetic testing may help identify these patients, offering the potential for individualized treatments. 

Dr. Yang Yi-Hsin introduced the National Biobank Consortium of Taiwan (NBCT), funded by the government and managed by the National Health Research Institutes (NHRI). NBCT collaborates with 4 research institutes and 31 hospitals to compile clinical and genetic data, facilitating research resources for the biomedical industry. It also partners with hospitals to build a common data model using patients’ electronic health records. This approach enables data analysis on diagnosis, treatment, and prognosis, promoting personalized cancer treatment and drug development.

International Examples of Genetic Data Management and Updates of Taiwan’s Regulations on LDTs

Liu Yu-Ching, Deputy Director General of the Department of Medical Affairs, MOHW, discussed genetic data management mechanisms in other countries and updated regulations on the management of laboratory-developed tests (LDTs) in Taiwan. She cited examples from Finland, the United Kingdom, and Japan, highlighting that a government’s management mindset and public trust influence genetic data management.

Liu suggested that Taiwan could learn from Finland, the UK, and Japan in genetic data management while addressing information security, privacy, and data utilization. She advocated for inter-departmental collaboration to establish common data formats following international standards.

Liu also introduced the MOHW’s amendment to regulations governing LDTs announced in February 2021. Key points included requiring medical institutions to apply for approval when conducting LDTs, certification for laboratories, and accreditation for overseas labs. These changes aim to ensure quality and regulatory compliance.

MTB As a New Trend in Precision Cancer Medicine

Dr. Lin Yung-Chang, Vice Superintendent of Chung Gung Memorial Hospital (CGMH) Linkou Branch, discussed molecular tumor boards (MTBs) in personalized cancer care. MTBs address challenges stemming from complex genetic test results, providing comprehensive evaluations and tailored therapeutic approaches. International studies show that MTB-based treatments improve clinical benefits, overall response rates, and progression-free survival.

However, based on the practical experience of CGMH in the past few years, he pointed out that challenges persist in MTB practices, such as variations in processes, limited patient access due to time constraints, lack of standardized tools, and questions about genetic test result quality and credibility. Dr. Lin called for standardized practices, including result discussions, report formats, and drug recommendation evidence. Cross-hospital genetic databases and virtual network MTBs may also enhance smaller hospitals’ capabilities.

Dr. Lin Yung-Chang explained the development of the Molecular Tumor Board (MTB) and shared the practical experience of MTB inplementation in CGMH Linkou Branch.

Experts Gather to Discuss Strategies for Promoting Personalized Cancer Care

Apart from expert presentations, the plenary session also included panel discussions, bringing together experts, doctors, scholars, and government representatives to explore policy and practical issues related to precision cancer care from multiple perspectives. Concerns included uncertainties surrounding the upcoming health insurance coverage for next-generation sequencing (NGS), the impact of family history and genetic risks in cancer diagnosis and treatment, healthcare resource constraints, budgetary suggestions, integrating the ICT industry with healthcare, enhancing patient involvement in healthcare decisions, and addressing data sharing challenges.

These discussions provided insights for Taiwan’s healthcare policymakers to formulate informed policies in this ever-changing field, helping the nation meet the challenges of the new era of precision medicine.

From left to right: Prof. Chen Li-Tzong, Dr. Wayne Huey-Herng Sheu, Dr. Jacqueline Whang-Peng,
Dr. James Chih-Hsin Yang, Dr. Yang Pan-Chyr, Prof. Cheng Ann-Lii

Advances in Precision Lung Cancer Treatment Cover Multiple Genetic Variants

The afternoon session delved into two breakout workshops: “Lung Cancer” and “Gastrointestinal Cancer.” In the lung cancer session, doctors from NTU Hospital and NTU Hospital Hsinchu Branch shared cutting-edge advances in precision medicine for lung cancer. Meanwhile, the GI cancer workshop featured three MTB demonstrations, aiming to raise awareness of molecular testing’s application through live discussions of real cases.

Dr. Ho Chao-Chi, Secretary General of the Taiwan Association for the Study of Lung Cancer, discussed molecular testing’s role in lung cancer treatment, emphasizing its application to non-small cell lung cancer (NSCLC). He highlighted the inclusion of various genetic mutations in treatment guidelines but noted the high cost of next-generation sequencing as a clinical challenge. Dr. Ho called for learning from overseas experiences and establishing a more effective health insurance coverage mechanism to improve patient survival.

Dr. Liao Wei-Yu and Dr. Lin Yen-Ting addressed exon 20 insertion and BRAF V600E mutation in NSCLC patients, offering insights into therapeutic options, drug resistance, and recent clinical studies. Dr. Wu Shang-Gin discussed MET exon 14 gene skipping in NSCLC management, while Dr. Lee Jih-Hsiang shared the clinical progress of Pralsetinib for NSCLC with RET gene fusion.

Expert Presentation and MTB Demonstration Showcasing New Treatment Strategies for GI Cancers

According to the MOHW’s 2022 Cause of Death Statistics, gastrointestinal (GI) cancers constitute half of Taiwan’s top 10 leading causes of cancer deaths (in order of ranking: liver and intrahepatic cholangiocarcinoma, colorectal cancer, pancreatic cancer, gastric cancer, and esophageal cancer). This underscores the demand for effective GI cancer treatments and their public health implications. The GI cancer workshop addressed colorectal cancer, hepatobiliary tract cancer, and pancreatic cancer (and ampullary cancer).

Prof. Lin Zong-Zhe, Clinical Associate Professor of NTU College of Medicine, discussed how next-generation sequencing can guide targeted therapy for liver and biliary tract cancers (BTC). He emphasized the paradigm shift in systemic treatment and the need for molecular classification to optimize treatment outcomes, particularly for BTC cases with diverse therapeutic targets. Immunotherapies also hold promise in treating these cancers.

The workshop featured MTB demonstrations on colorectal cancer, hepatobiliary tract cancer, and pancreatic cancer, co-hosted by seasoned oncologists from various institutions. Each demonstration was based on real cancer cases, presenting the patients’ conditions, treatment history and strategies, as well as genetic test results. Participants engaged with presenters, moderators, and experts, gaining insights into the practical application of precision medicine in GI cancers.

During the afternoon breakout session on GI Cancer, three MTB demonstrations were arranged, focusing on colorectal cancer, liver and biliary tract cancer and pancreatic cancer respectively, in which oncologists shared real-life cancer treatment cases and exchanged views with the moderator and the participants.

In conclusion, the “2023 Advanced Precision Cancer Medicine Summit” united professionals and policymakers to address the challenges and opportunities in advancing cancer care in Taiwan. With the exchange of clinical experiences, international references, and innovative policies, Taiwan aims to realize precision and personalized cancer care, benefiting a broader spectrum of patients.

Author

Richard Chau