PO.ADV02 · 患者倡导
加拿大各地ROS1阳性肺癌治疗可及性差距——呼吁公平、以患者为中心的照护
ROS1-positive lung cancer treatment access gap across Canada - A call for equitable, patient-centered care
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
标题：加拿大各地ROS1阳性肺癌治疗可及性差距——呼吁公平、以患者为中心的照护
背景：ROS1阳性非小细胞肺癌（NSCLC）占NSCLC病例的1-2%，然而尽管有效的靶向酪氨酸激酶抑制剂（TKI）已经可用，患者仍面临显著的治疗可及性障碍。本分析评估了加拿大各省ROS1 TKI覆盖的差异，为患者倡导和政策改革工作提供参考。
方法：我们对截至2026年3月加拿大全国范围内ROS1靶向疗法的公共药物覆盖政策进行了全面分析，考察了加拿大所有省和地区从一线到三线的治疗可及性。系统性地审查了覆盖政策、特殊准入项目和临床试验可及性。
结果：虽然一线药物（crizotinib、entrectinib）展现出普遍覆盖，但在加拿大晚线治疗可及性方面出现了深刻的不公平。二线覆盖要求逐案审查，并需记录不耐受而非疾病进展，这带来了临床和伦理挑战。任何晚线疗法通过公共资金实际上均无法获得（覆盖所有省份），迫使患者转向临床试验或中断治疗。针对耐药突变（repotrectinib、taletrectinib、zidesamtinib）和中枢神经系统（CNS）疾病的下一代TKI仍仅能通过临床试验获得。至关重要的是，在首个TKI线用尽后覆盖终止，为发生耐药的患者制造了"治疗悬崖"，尽管存在潜在有效的后续疗法。
结论：加拿大ROS1阳性NSCLC患者在一线治疗之外面临无法正当解释的延长生命疗法可及性障碍。疗法可用性与公共资金之间的脱节延续了健康不公平，并损害了精准肿瘤学原则。亟需政策改革以：（1）建立一致的加拿大全国覆盖框架，（2）实现基于疾病进展（而不仅是基于不耐受）的二线可及性，（3）为三线及针对耐药的疗法资金创建路径，以及（4）加快下一代TKI的审批时间表。在系统性覆盖改善实现之前，就临床试验机会和特殊准入路径向患者进行以患者为中心的知识传播仍然至关重要。本分析提供了一个循证框架，以支持患者倡导、为医疗服务提供者的咨询提供参考，并指导政策改革，迈向对ROS1靶向疗法的公平可及。
查看英文原文 English abstract
Title : ROS1-Positive Lung Cancer Treatment Access Gap Across Canada - A Call for Equitable, Patient-Centred CareBackground: ROS1-positive non-small cell lung cancer (NSCLC) represents 1-2% of NSCLC cases, yet patients face significant treatment access barriers despite availability of effective targeted tyrosine kinase inhibitors (TKIs). This analysis evaluates provincial coverage disparities for ROS1 TKIs across Canada to inform patient advocacy and policy reform efforts.
Methods : We conducted a comprehensive pan-Canadian analysis of public drug coverage policies for ROS1-targeted therapies as of March 2026, examining first-line through third-line treatment access across all Canadian provinces and territories. Coverage policies, exceptional access programs, and clinical trial availability were systematically reviewed.
Results : While first-line agents (crizotinib, entrectinib) demonstrate universal coverage, profound inequities emerge in advanced-line therapy access in Canada. Second-line coverage requires case-by-case review with documented intolerance rather than progression, creating clinical and ethical challenges. Any advanced-line therapies remain virtually inaccessible through public funding across all provinces, forcing patients toward clinical trials or treatment discontinuation. Next-generation TKIs addressing resistance mutations (repotrectinib, taletrectinib, zidesamtinib) and CNS disease remain accessible only through clinical trials. Critically, coverage termination after exhaustion of first TKI line creates a "therapeutic cliff" for patients who develop resistance, despite availability of potentially effective subsequent therapies.
Conclusions : Canadian patients with ROS1-positive NSCLC face unjustifiable barriers to life-extending therapies beyond first-line treatment. The disconnect between therapeutic availability and public funding perpetuates health inequities and undermines precision oncology principles. Urgent policy reform is needed to: (1) establish consistent pan-Canadian coverage frameworks, (2) enable progression-based (not just intolerance-based) second-line access, (3) create pathways for third-line and resistance-directed therapy funding, and (4) accelerate approval timelines for next-generation TKIs. Patient-centered knowledge dissemination regarding clinical trial opportunities and exceptional access pathways remains critical until systemic coverage improvements are achieved. This analysis provides an evidence-based framework to support patient advocacy, inform healthcare provider counselling, and guide policy reform toward equitable access to ROS1-targeted therapies.