Toward Timely and Equitable Advanced Biomarker Testing for Patients with Metastatic Cancer in Canada

Abstract

The explosion in biomarker testing over the past two decades continues to transform cancer care in Canada and around the world. Precision medicine is supported by identifying actionable mutations that direct therapeutic choices, thus improving survival and quality of life, especially for patients with advanced/metastatic disease. In addition, our growing understanding of the genetic basis of cancer is advanced by research employing ever-expanding databases of genetic mutations, therapies and outcomes. Despite this promising progress, however, access to biomarker testing remains inequitable across Canada, to the detriment of patients. Several underlying factors contribute to this situation, including the need for investment in and standardization of laboratory medicine infrastructure and processes, and the lack of suitable methods for cost/benefit evaluations to inform funding decisions. In 2024, a Canadian conference brought together patients, clinicians, researchers, policy-makers and scientists to address "Equitable Access to Advanced Biomarker Testing for Canadian Metastatic Cancer Patients". Two major themes arose from the conference: the urgent need to adopt comprehensive genomic profiling (CGP) as a standard of care across Canada, and the emerging role of liquid biopsy in accelerating access to biomarker testing for patients with advanced/metastatic cancer.

Keywords: biomarker testing; circulating tumor DNA (ctDNA); comprehensive genomic profiling; genomic medicine; genomic testing; liquid biopsy; molecular testing; mutational testing; next generation sequencing; precision medicine.

Figure 1

Comparison of Comprehensive Genomic Profiling (CGP) and traditional genetic testing.

Figure 2

Comparison of liquid biopsy and tissue biopsy methods.

Figure 3

Drug reimbursement process in Canada. Diagram adapted from Ward et al. [24].