[Precision medicine in oncology: A reality… without equity].

Abstract

The prognostic of certain cancers improved significantly in recent years thanks not only to the launch of innovative treatments but also to progress made in the diagnostic field. Thus, next-generation sequencing (NGS) became paramount to help characterizing tumors and selecting the most pertinent treatments. The survey conducted by a multi stakeholder committee, at the end of 2022, with 103 actors of the management of cancer patients (public and private centers, labs, prescribers, biologists, pathologists, direction) confirmed the heterogeneity of use of NGS tests across France due to, mainly, the lack of systematic reimbursement of related costs. Référentiel des actes innovants hors nomenclature de biologie (RIHN) covers, in a delayed and partial way, only half of costs engaged by centers. Only those with a critical mass of patients or with a sufficient funding capacity can guarantee an access to large panels. Postponing the initiation of a required treatment represents a risk of loss of opportunity for patients who cannot benefit of this technology. NGS large panels tests, an efficiency lever for cancer treatment, must be part of the care toolbox. Those with a demonstration of value created should nowadays be fully reimbursed by collectivity after HAS' evaluation, for a fair access throughout the territory. Precision diagnostic can open the way to a more personalized and efficient medicine.