Dr. Kumar Prabhash, Professor, Medical Oncology and Head of the Solid Tumour Unit at Tata Memorial Hospital, and Director, Homi Bhabha Cancer Institute, says lung cancer patients in India’s smaller cities continue to face serious gaps in diagnosis, biomarker testing and access to targeted treatment. In this interview, he explains how the LuNGS Alliance is working to expand access to free NGS-based biomarker testing and why precision oncology remains out of reach for many patients outside major metros.
Q. What is the current situation for lung cancer patients in India’s tier II and tier III cities in terms of diagnosis and treatment?
Overall, the number of lung cancer cases in India ranges between an estimated 80,000 and 100,000 new cases per year. These are the new cases, and there are a whole lot of challenges throughout the journey.
The challenges start from diagnosing patients early, so that we are able to detect them at an early stage and potentially cure them. Then comes getting the biopsy done, having the special tests that are required, ensuring surgical facilities and radiation facilities are available, and making newer diagnostic test facilities accessible for treatment purposes. This also includes access to PET scans, daycare facilities, and the availability of medical oncologists.
So, when we look at this entire ecosystem of challenges, what we tried doing from our side was to address one specific problem. One of those problems, as I mentioned, was the special test, which we call genomic testing or molecular testing, for lung cancer patients, which is essential in today’s time, but has limited availability and accessibility. Enabling patients to get this test done was the focus of this LuNGS Alliance.
Q. Why is routine biomarker testing still not standard for lung cancer in non-metro parts of India?
It is a standard of care globally, and in India, even in tier two, tier three and tier four cities as well. However, the challenge is that due to various reasons, many patients are not able to access it.
The reasons again include multiple factors, starting with awareness among patients and clinicians, then the ability to get the biopsy done, because a lung biopsy requires a certain level of skill and infrastructure. Then, there is the need to send the test to an appropriate lab where it can be processed, because in most tier two and tier three cities, this testing is not available locally and has to be sent to specialised labs.
There is also a cost component, as it is often not covered under either government or private insurance, which further impacts accessibility. So, while it is a standard of care even here in India, it is not regularly done here because of the various reasons mentioned above.
Q. How did the LuNGS Alliance initiative come about, and what specific gaps in lung cancer care were it designed to address?
So once we identified the problem we were passionate about, a group of us from CRSF, Cancer Research and Statistics Foundation, scientists, pathologists and clinicians, came together. The idea was to make this test available as widely as possible. The first thing we understood was that we would need resources to ensure the test is accessible at scale, and also to bridge several other gaps, but most importantly, to secure those resources.
We then started exploring partnerships with people and organisations who had a similar interest. Within CRSF, we had people like Dr. Vanita Noronha, Dr. Ullas Batra, Dr. Amit Dutt and Dr. Anuradha Choughule, and together we began engaging in dialogue with external stakeholders, particularly from the pharma industry, who also had an interest in enabling such testing.
We reached out to multiple partners, including AstraZeneca, Pfizer, Roche, Johnson & Johnson and Eli Lilly. Subsequently, Tata Capital also came on board. These discussions gradually led to a shared understanding that if we could pool resources in one place, it could make this testing accessible to any clinician who wanted to get it done. Over time, these partners agreed, and we were able to build a system that ensured this test could be made available for anyone who needed or wanted it.
The testing is powered by 4baseCare’s TARGT First Solid test, which offers a comprehensive analysis of 72 commonly mutated genes and identifies actionable biomarkers that enable personalized treatment plans based on a patient’s unique genomic profile.
Q. What role do the partners play, and how does the TARGT First Solid test by 4baseCare work? What advantage does it offer by analysing 72 commonly mutated genes?
Coming to the partners involved in the alliance, CRSF provides the platform and includes the clinicians I mentioned earlier. The second group of partners are those who provide the resources, including AstraZeneca, Roche, Pfizer, Eli Lilly, Johnson & Johnson and also Tata Capital. These partners support the initiative financially, and the funds are managed through a separate audited account.
As far as the lab is concerned, the selected lab plays a very important role. It was chosen based on its ability to deliver quality results, maintain turnaround time and remain cost-effective. In addition to testing, they also coordinate sample collection and ensure reports are sent back to the respective clinicians. So overall, all partners, including 4baseCare, are extremely important in this initiative, and each of them plays a critical role in making this ecosystem work effectively.
Q. How does the LuNGS Alliance identify and enrol patients from smaller towns such as Varanasi, Jammu, parts of Rajasthan, Coimbatore and Kashmir?
We had a group of neutral stakeholders who were invited, along with all the labs that were interested in participating. In front of all the partners who were willing to support with resources, as I mentioned earlier, these stakeholders came together and evaluated the labs based on presentations covering cost, quality and turnaround time for the test.
After this evaluation process, we selected the lab that was most cost-effective, because we wanted to ensure that every rupee provided to us was used in the most efficient manner. Once this was finalised, we set up the process, which is now hosted on the website.
Anyone can go to the website, click on it and fill out a form. After this, someone from 4baseCare automatically contacts the clinician to confirm two things: that this is a unique patient and that it is a lung cancer case. Once this is verified, the patient becomes eligible.
The sample blocks are then collected by the lab team from any part of the country. They are transported to the 4baseCare lab where the test is conducted, and within 10 days, the report is sent back to the clinician who has ordered it. There are no additional checks or barriers beyond this. Anyone can access the website and get this test done.
What we are also doing is that, after sharing the report with the clinician, we are placing anonymised data on a neutral platform, which can be accessed by people interested in academics, training, education and further research.
Q. Among the first 100 LuNGS tested patients, 64% had mutations with matched targeted therapies. What does this tell you about the importance of routine NGS for Indian patients?
Data on mutation testing and treatment based on this testing has already been well established for patients treated abroad. Now, we also have data from India, developed from our own patient population, and we see that our patients benefit in a very similar way.
For example, if you do not have this test and give treatment without it, or give random treatment, then the average life of these patients is around six to eight months. But if you can do this test and then give treatment based on it, these patients may live four to five years or beyond, and in some groups, the five-year survival is around 80%.
So, there is a huge difference in outcomes depending on whether we treat patients based on these tests or without these tests. This becomes extremely important for our patients. Apart from the data we see from abroad, our own data also suggests the same. If the test is not available, this kind of treatment cannot be planned, so this test is critical for improving the quality of life and increasing survival significantly.
In fact, these treatments are often oral tablets, and patients are able to take them and continue their normal daily work. Even in stage four lung cancer, if a patient is mutation positive, it can be as simple as taking a tablet a day and continuing routine life activities.
Q. How do targeted therapies such as EGFR, ALK, ROS1 and BRAF inhibitors typically change survival and quality of life compared with chemotherapy alone in lung cancer?
So, if we give a random treatment, the average survival is around half a year, about six to eight months. But if we are able to give treatment based on mutation testing, the average survival increases significantly by years. It can be four to five years, so what was earlier 6 to 8 months becomes around 60 to 70 months and beyond. In some groups of patients, the survival is almost 8 to 10 years and beyond.
So, it leads to a dramatic and significant improvement in survival for these patients when we are able to treat them based on mutation testing. In terms of quality of life, these treatments are usually non-toxic and oral, so they are easy to take. Patients are able to continue their normal daily activities and work, so the treatment does not compromise their overall quality of life. In fact, it improves it.
Q. Walk us through the actual process: how are tissue or blood samples collected, sent, tested and reported under LuNGS, and how long does it usually take?
Once people apply, someone from the lab side contacts the concerned clinician. After verification is completed, the tissue samples are collected and transported to the central lab, which may be at one or more designated locations.
At the central lab, the tissue blocks are processed, and DNA is extracted from the sample. Once the DNA is extracted, the test is run on specialised machines. After that, the data is analysed through a dedicated software pipeline, and the results are interpreted. Once the report is generated and verified by the lab, it is sent back to the clinician.
The clinician then shares the report with the patient, and based on that, the clinician and patient decide the most appropriate treatment option. Once it is agreed upon, the clinician proceeds with the treatment accordingly.
Q. Why have AstraZeneca, Pfizer and Roche chosen to support LuNGS Alliance, and what specific contributions do they make beyond funding?
AstraZeneca, Pfizer and Roche have primarily supported the LuNGS Alliance through funding, which has been crucial for sustaining and expanding the initiative. Importantly, their involvement has been non-intrusive and free from implementation-related conditions. They do look into how it is getting implemented. So, data regarding how many patients have undergone testing, whether the tests are happening on time or not, is shared with all the stakeholders in this initiative. However, patient identification and privacy are completely maintained, and no one is aware of patient details except the treating clinician and the lab where it goes.
Beyond funding, they also provide constructive feedback from the ground, wherever challenges are identified.
Q. What exact role does 4baseCare play as the official lab partner, and how does the programme maintain sample quality, data privacy and timely reporting across states?
Quality is constantly being checked by our scientists on board at CRSF, who monitor how the tests are being conducted and whether the quality is being maintained or not.
Coming to data privacy, except the clinician who is sending the test to the lab, no one knows the details about the patient. The patient data and the test report are maintained in an anonymized manner, without patient identification, so no one knows which patient it is. That is only known to the clinician who is sending it and the lab personnel who are receiving it. From then onwards, it is completely anonymized data that is being maintained. Whenever it is presented or discussed, it is ensured that no patient data is ever discussed with identification.
Now, coming to timely reporting, we have committed a turnaround time of 10 to 12 working days for the reports. We continuously monitor whether the test reports are reaching clinicians within this timeline. This data is regularly analyzed with all stakeholders and reviewed every month or two to assess whether these parameters are being met. In the majority of cases, we are able to provide the reports within the committed timeframe.
Q. What are the biggest logistical, financial and clinical challenges LuNGS Alliance faces in delivering free, advanced biomarker testing to patients in smaller towns?
The first challenge is limited resources. Last year, we were able to provide free testing to around 5,000 patients. However, there are almost 80,000 plus lung cancer patients diagnosed, so we are not able to provide tests for everybody. That is the reason we are looking for more partners, because if we want to increase the number of tests, we will need more resources and support.
The second challenge is the lack of trained interventional radiologists in tier two and tier three cities. In some places, the expertise is very good, and there are excellent radiologists, including many young doctors who are able to provide good biopsy samples. But there are also places where there are limitations. We are trying to address this through training programs so that we can build trained personnel in those cities and regions.
The third challenge is the operational pressure on lab personnel across India. They need to remain vigilant and coordinated so that tissue blocks and samples are collected properly and sent to the lab on time. That itself is a major logistical exercise. I must say that lab teams have managed this very well, but it does place an additional burden on them.
As of now, because of resource limitations, we have mainly been able to conduct these tests on tissue samples. There is also evidence that these tests can be done through blood samples, and ideally, if both approaches can be used, it would be far better for patients. However, because of resource constraints, we have not yet been able to do that.
Another important challenge is ensuring that every patient who undergoes testing is actually able to access targeted therapy or immunotherapy based on the report. A good number of patients do receive these treatments, but there are still patients who face different barriers and limitations. We are continuously trying to find ways to improve access to treatment for them as well.
Every good initiative also comes with its own set of challenges, and these are some of the key issues we are currently dealing with.
Q. In your opinion, what would it take for India to shift from isolated cases of personalised lung cancer care to a routine, nationwide standard of care accessible to all patients, including those in tier II and tier III cities?
Personalised lung cancer care is already the standard of care for all patients, but unfortunately, due to many reasons, a lot of patients are not able to access it.
It will require a lot of effort from many people at multiple levels. It will need multiple initiatives and greater awareness among clinicians, more awareness among patients, and wider support from both state and central governments. It will also require support from more people in society. Many organisations and individuals currently donate funds for treatment, but we also need them to support testing, because if you do not do the testing, you cannot give the right treatment.
There is also a need to make these treatments more accessible and affordable. Many of these therapies are expensive, so either they need to be supported financially by different stakeholders, or we need to develop more of these treatments in India itself. If these treatments are developed in India, they can become far more cost-effective.
So, overall, it will require a collective effort from multiple stakeholders to make personalised lung cancer care a pan-India standard and ensure that it becomes available to every patient in the country.
Voices from the Oncology Community and Industry
Dr. Vanita Noronha, Professor and Medical Oncologist, Tata Memorial Hospital, Mumbai, and Editor-in-Chief, Cancer Research Statistics and Treatment (CRSTonline.com), said access to biomarker testing is central to improving outcomes. She said:
“Access to biomarker testing is fundamental to ensuring that patients with lung cancer receive the most appropriate and effective treatment. Despite its importance, significant barriers to testing persist for many patients across India. The LuNGS initiative, spearheaded by Dr Kumar Prabhash, has demonstrated the value of collaboration among clinicians, scientific experts, and other key stakeholders in addressing these challenges and advancing access to precision oncology. It is particularly encouraging to observe the program’s impact and reach among underserved populations over the past year. Continued expansion of this initiative has the potential to further strengthen equitable access to biomarker-driven cancer care and serve as a scalable model for improving oncology outcomes across the country.”
Dr. Anuradha Choughule, Professor and Faculty Scientist and Consultant, Molecular Laboratory, highlighted the equity impact of the programme. She said:
“By enabling thousands of patients, including a large proportion from underserved communities, to access precision oncology, the program has demonstrated that equitable cancer care is achievable when scientific expertise, clinical partnerships and public health mechanisms work together.”
From a practising clinician’s perspective, Dr. Kalpesh Prajapati, Hemato Oncology Clinic, Vedanta, underlined the affordability barrier. He said:
“In the modern era of precision oncology, we face significant challenges in timely biomarker testing in many of our lung cancer patients. The primary challenge is the non-affordability of poor patients. With this remarkable and unique LuNGS initiative, we have been able to guide our patients to better treatment options based on biomarker testing reports.”
On the industry side, Praveen Akkinepally, Country President, AstraZeneca Pharma India Limited, said the initiative reflects the power of partnership in addressing gaps in access. He said:
“The LuNGS Alliance reflects AstraZeneca’s belief in the power of partnership to help advance care in the country. Rooted in our purpose to push the boundaries of science to deliver life-changing medicines, this cross-sector partnership is helping democratise NGS-based biomarker testing across India, bridging critical gaps in access and awareness, and enabling more timely, informed treatment decisions in resource-constrained settings.”
Together, these perspectives underline how the LuNGS Alliance is emerging as a model for making precision lung cancer care more equitable and for bringing state-of-the-art biomarker testing within reach of patients far beyond India’s metros.
