Johnson & Johnson launches The 3rd Opinion in Asia Pacific: a new term to elevate the patient voice in the lung cancer treatment journey
- Newly published research shows up to 77% of patients in Asia Pacific trust and rely on their physicians to decide their treatment for them despite 69% of physicians encouraging patients to engage in shared decision making1.
According to newly published data on NSCLC patient preferences in Future Oncology, up to 77% of patients in Asia Pacific trust and rely on their physicians to decide their treatment for them despite 69% of physicians encouraging patients to engage in shared decision making[1]. Cultural norms around stigma, not questioning authority, and limited understanding of the disease can often be major barriers causing patients not to voice concerns or ask questions, even when healthcare professionals actively encourage their input.
"Being diagnosed with lung cancer is overwhelming. It's natural for patients to seek clarity, often by pursuing a second opinion, to better understand their condition and treatment options. However, patients often hesitate to express their concerns and treatment goals, causing them to be overlooked in the decision-making process. By creating space for the patient's own opinion, The 3rd Opinion, creates a new way of thinking about lung cancer treatment and empowers patients to find their voice," said Anthony Elgamal, Vice President of Oncology, Johnson & Johnson Innovative Medicine Asia Pacific.
Lung cancer has the highest incidence and mortality rate of all cancers worldwide, with more than 2.5 million people diagnosed every year, and Asia makes up 63% of all patients[2]. Up to 85% of lung cancers are non-small cell lung cancer (NSCLC) and Asians are more prone to certain genetic mutations than the rest of the world. One of the most prevalent is a mutation known as EGFR where 30-40% of all NSCLC diagnoses are in Asia, compared to 10-15% in the United States and Europe[3][4][5]. Often being diagnosed at a late stage, less than 20% of people with these genetic mutations survive beyond five years[6], and up to 40% never get the chance to receive a subsequent therapy after first-line treatment.[7][8][9]
"With the disproportionately high prevalence of certain NSCLC mutations in Asia Pacific, we need to think differently about how we treat patients and what more we can achieve with the first treatment. Treatment options have become increasingly complex and clinical decision making should comprehensively consider disease characteristics, patient treatment goals and values, and aim for an individualized balance between survival, longer lasting disease control and side effects. When shared decision making includes all available options, the final decision can be made collaboratively," said Prof James Chih-Hsin Yang, Director of National Taiwan University Cancer Center and key advocate for The 3rd Opinion initiative.
Mark Brooke, Chief Executive Officer of Lung Foundation Australia, co-author of the Future Oncology publication and an advocate of The 3rd Opinion agreed, "The physician and patient dynamic is one of trust, but we cannot rely on that alone. The consequence is a potential disconnect between the patient and their healthcare professional around treatment preferences and personal goals. For patients, they often want more time above all else - to witness life's milestones, more moments with loved ones, and more opportunities to simply live. Patients need to be equipped with adequate disease and treatment information, so they can communicate what matters most to them".
The 3rd Opinion will be launched across multiple markets with educational resources, including a Lung Cancer Book of Answers in China, a patient empowerment video and various shared decision making tools across Asia Pacific to spark a social movement that encourages patients to confidently articulate their personal goals for treatment. The creation of a neologism, like The 3rd Opinion, ensures shared decision making becomes accepted into clinical practice and in turn fosters an environment where the doctor's expertise and the patient goals come together to design the best treatment plan.
[1] Chee Khoon Lee et al. Navigating advanced lung cancer care, patient–physician alliance, cancer stigma, and psychosocial support in Asia-Pacific: perspectives from patients, caregivers, and physicians. DOI: 10.1080/14796694.2025.2499511
[2] Natia Jokhadze MD, Arunangshu Das MBBS, Don S. Dizon MD. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Volume 74Issue 3CA: A Cancer Journal for Clinicians pages: 224-226 First Published online: April 4, 2024
[3] Keedy VL, et al. American Society of Clinical Oncology Provisional Clinical Opinion: Epidermal Growth Factor Receptor (EGFR) Mutation Testing for Patients with Advanced Non-Small-Cell Lung Cancer Considering First-Line EGFR Tyrosine Kinase Inhibitor Therapy. Journal of Clinical Oncology. 2011; 29(15): 2121-2127.
[4] Ellison G, et al. EGFR Mutation Testing in Lung Cancer: a Review of Available Methods and Their Use for Analysis of Tumour Tissue and Cytology Samples. Journal of Clinical Oncology. 2013; 66(2): 79-89.
[5] Korpanty G, et al. Biomarkers That Currently Affect Clinical Practice in Lung Cancer: EGFR, ALK, MET, ROS-1, and KRAS. Frontiers in Oncology. 2014; 4: 204.
[6] Bazhenova L, Minchom A, Viteri S, et al. Comparative clinical outcomes for patients with advanced NSCLC harboring EGFR exon 20 insertion mutations and common EGFR mutations. Lung Cancer. 2021;162:154-161.
[7] Nieva J, Karia PS, Okhuoya P, et al. A real-world (rw) observational study of long-term survival (LTS) and treatment patterns after first-line (1L) osimertinib in patients (pts) with epidermal growth factor receptor (EGFR) mutation-positive (m) advanced non-small cell lung cancer [ESMO abstract 1344P]. Ann Oncol. 2023;34(suppl 2):S774
[8] Lee JY, Mai V, Garcia M, et al. Treatment patterns and outcomes of first-line osimertinib-treated advanced EGFR mutated NSCLC patients: a real-world study [IASLC abstract EP08.02-082]. Presented at: IASLC 2022 World Lung Conference on Lung Cancer; August 6-9, 2022; Vienna, Austria.
[9] Girard N, Leighl NB, Ohe Y, et al. Mortality among EGFR-mutated advanced NSCLC patients after starting frontline osimertinib treatment: a real-world, US attrition analysis. Presented at: the European Lung Cancer Congress; March 29-April 1, 2023; Copenhagen, Denmark. Poster 19P.
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About The 3rd Opinion
"The 3rd Opinion", the patients own opinion, is a new term that sparks a social movement in the lung cancer treatment journey – designed to elevate the patient voice and empower individuals to take an active role in shaping their treatment plan. By prioritizing shared decision-making between patients and healthcare professionals, this collaborative approach ensures that treatment choices are aligned to each patient's goals, preferences and circumstances. This results in more informed decisions, greater patient satisfaction, and the best possible outcomes.
About Non-Small Cell Lung Cancer
Worldwide, lung cancer is one of the most common cancers, with NSCLC making up 80 to 85 percent of all lung cancer cases.[10], [11] The main subtypes of NSCLC are adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.[12] Among the most common driver mutations in NSCLC are alterations in EGFR, which is a receptor tyrosine kinase controlling cell growth and division.[13] EGFR mutations are present in 10 to 15 percent of Western patients with NSCLC with adenocarcinoma histology and occur in 40 to 50 percent of Asian patients.[14], [15],[16],[17],[18],[19] EGFR ex19del or EGFR L858R mutations are the most common EGFR mutations.[20] The five-year survival rate for all people with advanced NSCLC and EGFR mutations treated with EGFR tyrosine kinase inhibitors (TKIs) is less than 20 percent. [21], [22] EGFR exon 20 insertion mutations are the third most prevalent activating EGFR mutation.[23] Patients with EGFR exon 20 insertion mutations have a real-world five-year overall survival (OS) of eight percent in the frontline setting, which is worse than patients with EGFR ex19del or L858R mutations, who have a real-world five-year OS of 19 percent.[24]By comparison, other common cancers, such as breast and prostate cancer have a 5-year real world OS of 90% and 97% respectively[25].
[10]The World Health Organization. Cancer. https://www.who.int/news-room/fact-sheets/detail/cancer. Accessed March 2025.
[11] American Cancer Society. What is Lung Cancer? https://www.cancer.org/content/cancer/en/cancer/lung-cancer/about/what-is.html. Accessed March 2025.
[12] Oxnard JR, et al. Natural history and molecular characteristics of lung cancers harboring EGFR exon 20 insertions. J Thorac Oncol. 2013 Feb;8(2):179-84. doi: 10.1097/JTO.0b013e3182779d18.
[13] Bauml JM, et al. Underdiagnosis of EGFR Exon 20 Insertion Mutation Variants: Estimates from NGS-based Real World Datasets. Abstract presented at: World Conference on Lung Cancer Annual Meeting; January 29, 2021; Singapore.
[14] The World Health Organization. Cancer. https://www.who.int/news-room/fact-sheets/detail/cancer. Accessed March 2025.
[15] American Cancer Society. What is Lung Cancer? https://www.cancer.org/content/cancer/en/cancer/lung-cancer/about/what-is.html. Accessed March 2025.
[16] Pennell NA, et al. A phase II trial of adjuvant erlotinib in patients with resected epidermal growth factor receptor-mutant non-small cell lung cancer. J Clin Oncol. 37:97-104.
[17] Burnett H, et al. Epidemiological and clinical burden of EGFR exon 20 insertion in advanced non-small cell lung cancer: a systematic literature review. Abstract presented at: World Conference on Lung Cancer Annual Meeting; January 29, 2021; Singapore.
[18] Zhang YL, et al. The prevalence of EGFR mutation in patients with non-small cell lung cancer: a systematic review and meta-analysis. Oncotarget. 2016;7(48):78985-78993.
[19] Midha A, et al. EGFR mutation incidence in non-small-cell lung cancer of adenocarcinoma histology: a systematic review and global map by ethnicity. Am J Cancer Res. 2015;5(9):2892-2911.
[20] American Lung Association. EGFR and Lung Cancer. https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/symptoms-diagnosis/biomarker-testing/egfr. Accessed March 2025.
[21] Howlader N, et al. SEER Cancer Statistics Review, 1975-2016, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2016/, based on November 2018 SEER data submission, posted to the SEER web site.
[22] Lin JJ, et al. Five-Year Survival in EGFR-Mutant Metastatic Lung Adenocarcinoma Treated with EGFR-TKIs. J Thorac Oncol. 2016 Apr;11(4):556-65
[23] Arcila, M. et al. EGFR exon 20 insertion mutations in lung adenocarcinomas: prevalence, molecular heterogeneity, and clinicopathologic characteristics. Mol Cancer Ther. 2013 Feb; 12(2):220-9.
[24] Girard N, et al. Comparative clinical outcomes for patients with NSCLC harboring EGFR exon 20 insertion mutations and common EGFR mutations. Abstract presented at: World Conference on Lung Cancer Annual Meeting; January 29, 2021; Singapore.
[25] Surveillance, Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2024.
About Johnson & Johnson
At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity.
Learn more at https://www.jnj.com/ or at www.innovativemedicine.jnj.com. Follow us at @JNJInnovMed.
