Affordable testing can be the next hope for cancer patients

Duty exemptions will support better patient outcomes and encourage the integration of advanced medical technologies into the Indian healthcare landscape.

Last week, India’s Finance Minister Nirmala Sitharaman announced a tax waiver for three cancer drugs — trastuzumab deruxtecan, osimertinib and durvalumab — in the Union Budget for 2024-25.

The 10 percent Integrated Goods and Service Tax (IGST) exemption is expected to benefit cancer patients by reducing their financial burden and expanding access to advanced treatment options.

Traditional chemotherapy attacks fast growing cancer cells along with healthy cells while targeted therapy focuses on an individual tumor’s specific molecules and their affected cellular pathways that are important for cancer cell growth and survival.

For example, trastuzumab deruxtecan is a targeted treatment of HER2-positive breast and gastric cancers. It works by killing cancer cells, specifically HER2-positive cancer cells.

Osimertinib is a targeted therapy for lung cancer, specifically non-small cell lung carcinoma. It is a third-generation tyrosine kinase inhibitor (TKI), a medicine that blocks proteins called tyrosine kinases which send signals to cancer cells to multiply. TKIs help stop the growth of cancer cells and sometimes even kill them.

It is used to treat specific mutations in the epidermal growth factor receptor (EGFR) gene, a protein on cells that helps them grow. It is particularly effective against the EGFR T790M mutation, which often develops after resistance to first- and second-generation EGFR TKIs.

Durvalumab is an immunotherapy drug used to treat various cancers, including non-small cell lung cancer and bladder cancer. It blocks the PD-L1 protein which tumors use to evade the immune system, thereby enabling the body’s immune cells to attack the cancer. ​

In the current era of precision medicine, there is potential for better clinical outcomes, including higher response rates and extended progression-free survival, by using drugs designed to target cancer cells more precisely.

More effective cancer treatment

The most crucial step in cancer treatment involves making a timely diagnosis, analysing the tumor composition through molecular testing and administering the appropriate treatment.

Enhanced access allows oncologists to prescribe these targeted medications more effectively, based on molecular testing and specific cancer profiles.

With a reduction in costs, these drugs will result in increased adoption in hospitals and cancer treatment centres across India. This could also prompt healthcare providers to integrate more advanced treatment protocols and choose molecular testing upfront which increases drug choice.

One in nine Indians is likely to develop cancer in their lifetime. The incidence of cancer in India is expected to rise by 12.8 percent between 2020 and 2025. This increase emphasises how critical it is to change the status quo and lower the cancer burden.

Modern cancer treatments, such as targeted therapies and immunotherapies, are often very expensive, costing between INR 2-3 lakh ($US2,400-3,600). These drugs are typically priced high due to the complexity of their development and manufacturing.

Even traditional chemotherapy drugs can be costly, especially when used in combination or over long periods.

Tests such as CT scans, MRIs, PET scans and molecular diagnostics such as next-generation sequencing — a faster and cheaper technology to analyse the genetic information in DNA that helps doctors identify specific genetic changes, leading to more precise and personalised treatments — are costly and are often repeated at different stages of treatment.

It is well- known that cancer treatment expenses are both financially and emotionally draining for patients and their families. Continuous follow-up visits, monitoring and supportive care increase the overall cost.

Cancer patients frequently require prolonged and expensive hospital stays. Patients often travel to specialised cancer centers, incurring significant travel and accommodation costs, especially for those living in rural or remote areas.

How subsidies can help

The next step is to consider relaxing IGST for FDA-approved companion diagnostic kits, tests that help doctors determine if a specific treatment is right for a patient based on their genetic makeup.

These kits ensure that patients receive medications that are most likely to work for their particular condition, making treatment more effective and personalised.

This would encourage Indian medical laboratories to adopt higher-quality kits and help oncologists to use the therapies upfront.

Currently, FDA companion diagnostic molecular testing is often sent abroad, which poses a higher risk of sample degradation, especially with liquid biopsies and delayed deliveries of tissue blocks which further impacts the release of reports.

Testing failures and requests for repeat sampling further delay the process. Every minute counts for a cancer patient.

India has significant expertise in medical oncology and molecular pathology, but funding remains a major challenge.

The government can address these issues, which can directly impact medical understanding of the unique patterns of genetic changes or mutations found in the cancer cells of Indians and help build Indian cancer databases. This can further support clinical trials.

It would be beneficial if adjuvant testing for targeted therapies, such as next-generation sequencing, could be subsidised. This would allow every cancer patient to access these tests during the initial diagnostics and monitor their response to the chosen treatment.

This will help doctors track the cancer, check if treatments are working, assess risks, spot new signs of cancer changes, and understand why a treatment might stop working. This can lead to more personalised and effective treatment plans.

The focus on personalised medicine ensures that patients receive therapies tailored to the specific molecular characteristics of their tumors, which is crucial for the effective management of cancer.

Duty exemptions will have a significant positive impact on the administration of drugs for Indian patients, making cutting-edge cancer therapies more accessible and aligned with global trends towards personalised and targeted cancer treatment.

Dr Bhardwaj Tina Neelesh is Head-Oncogenomics, Department of Molecular Genetics, Lifecell Diagnostics, Chennai. She is also a PhD Scholar at the School of Engineering and Technology, Manav Rachna International Institute of Research & Studies, Faridabad.

Dr Kanchan Bhardwaj is Professor at the School of Engineering and Technology, Manav Rachna International Institute of Research & Studies, Faridabad. She is also a TARE SERB Fellow at the Regional Centre for Biotechnology, Faridabad

Originally published under Creative Commons by 360info™.