Belgium has published its National Cancer Plan 2026–2036, setting out 34 actions to improve cancer prevention, diagnosis, treatment, research and quality of life over the next decade.
For people living with ALK-positive non-small cell lung cancer (NSCLC), several proposed measures are particularly relevant, including improved access to molecular testing, specialised cancer care, innovative treatments and emerging technologies such as liquid biopsy.
At ALK Positive Belgium, we welcome these developments and will closely follow how the plan translates into improvements in patient care.
Better Access to Molecular Testing
ALK-positive lung cancer is driven by a genetic alteration involving the ALK gene. Identifying this alteration through appropriate biomarker testing is essential for selecting targeted treatment.
The new Cancer Plan proposes reviewing reimbursement arrangements for biomarker testing, including broader genomic panels using next-generation sequencing (NGS) and comprehensive genomic profiling (CGP). It also aims to develop a more integrated funding model in which reimbursement for diagnostic tests is better aligned with the use of precision medicines (Action 23).
This matters for ALK-positive lung cancer because patients may require different types of molecular testing at different stages of their disease, particularly if resistance to treatment develops.
Access to comprehensive and timely biomarker testing should not depend on the hospital where a patient receives their diagnosis.
Liquid Biopsy and ctDNA: An Important Development
One particularly relevant aspect of the new Cancer Plan is its explicit recognition of liquid biopsy using circulating tumour DNA (ctDNA) (Action 23).
Liquid biopsy allows clinicians to analyse tumour-derived genetic material found in a blood sample, offering a less invasive alternative or complement to tissue biopsy in certain situations.
The plan acknowledges that existing reimbursement arrangements do not fully reflect current clinical practice, which increasingly uses broad genomic panels and liquid biopsies. It also recognises that biomarkers are important not only when treatment begins but also during patient follow-up.
The National Institute for Health and Disability Insurance (INAMI/RIZIV) is responsible for work on a more integrated reimbursement framework, scheduled to begin in the second half of 2027. The proposed framework aims to accommodate advances in molecular diagnostics while considering their clinical value and cost-effectiveness. (health.belgium.be)
Why does this matter for ALK-positive lung cancer?
Liquid biopsy can be useful when investigating acquired resistance to ALK-targeted treatments. By analysing ctDNA, clinicians may identify molecular changes that help inform subsequent treatment decisions.
Researchers are also investigating two additional applications.
Molecular residual disease (MRD)
Following treatment with curative intent, highly sensitive ctDNA testing may detect molecular evidence of residual cancer even when conventional imaging shows no detectable disease.
Research suggests that ctDNA-MRD testing may help identify patients at increased risk of recurrence. However, further evidence is needed to establish whether changing treatment based on MRD results improves clinical outcomes in NSCLC.
Serial molecular monitoring
In advanced ALK-positive lung cancer, repeated ctDNA testing is being studied as a way to monitor treatment response and potentially identify molecular signs of emerging resistance before progression becomes visible on imaging.
This could eventually help clinicians better understand how tumours respond to targeted therapies over time.
However, routine serial ctDNA monitoring is not yet an established standard of care in advanced ALK-positive NSCLC.
An important limitation is that some tumours release very little ctDNA into the bloodstream. This is particularly relevant for disease confined to the central nervous system, where blood-based testing may fail to detect active cancer. A negative ctDNA result therefore does not necessarily mean that cancer is absent and cannot replace appropriate imaging.
Although the National Cancer Plan explicitly recognises liquid biopsy and the growing importance of molecular testing during follow-up, it does not specifically establish ctDNA-MRD testing or routine serial ctDNA monitoring as reimbursed services.
Further clinical research and evaluation will be needed to determine how these emerging applications can be integrated into routine cancer care.
Specialised Lung Cancer Centres and Molecular Tumour Boards
The Cancer Plan proposes concentrating selected complex aspects of cancer care in specialised centres while allowing other services to remain closer to patients’ homes.
Thoracic oncological surgery, including lung cancer surgery, is identified as a priority area. The plan sets 30 June 2028 as the target date for organising lung cancer care within this framework (Action 5). This does not mean that all lung cancer treatment will be transferred to specialised centres.
The plan also provides for a National Molecular Tumour Board, planned for 2028 (Action 8).
A Molecular Tumour Board brings together specialists in oncology, molecular pathology and other relevant disciplines to interpret complex molecular findings and support treatment decisions.
For patients with ALK-positive lung cancer, this could be particularly valuable when unusual molecular alterations or resistance mechanisms emerge.
Ensuring that patients treated outside major cancer centres can access this expertise will be important. (health.belgium.be)
Access to Innovative Treatments and Clinical Trials
The Cancer Plan also addresses access to innovative cancer medicines.
It includes monitoring the impact of early-access programmes for people with cancer (Action 28) and examining a sustainable financing framework for selected off-label treatments in rare and complex cancers (Action 7).
However, the plan does not specify whether ALK-positive lung cancer would fall within the scope of the proposed off-label treatment framework.
For people living with advanced ALK-positive lung cancer, access to newer targeted therapies and clinical trials can become particularly important when existing treatments stop working.
The plan also proposes improving clinical trial organisation and exploring decentralised trial activities (Action 25).
These measures could eventually reduce the burden of travelling to specialist centres by allowing certain study procedures to take place closer to patients’ homes.
However, these proposals do not yet guarantee access to specific treatments or clinical trials.
Lung Cancer Screening and Earlier Diagnosis
The Cancer Plan proposes evaluating the feasibility of risk-based lung cancer screening, considering scientific evidence, health benefits, cost-effectiveness, healthcare capacity and budgetary implications (Action 19).
This is relevant to ALK-positive lung cancer, which can occur in younger people and individuals who have never smoked.
Although lung cancer screening programmes generally focus on populations at elevated risk, earlier recognition and investigation of lung cancer symptoms in people outside traditional screening groups also deserves attention.
For ALK Positive Belgium, this includes raising awareness that lung cancer is not exclusively a smoking-related disease and that persistent or concerning symptoms should be appropriately investigated, regardless of smoking history.
The plan does not establish a nationwide lung cancer screening programme. It commits to assessing whether risk-based screening would be feasible, beginning with lung cancer during the current legislative period.
Quality of Life and Living with Cancer
Advances in targeted treatments mean that some people with advanced ALK-positive lung cancer are living for extended periods while continuing treatment.
The Cancer Plan recognises the importance of supportive care, rehabilitation, patient-reported outcomes and the long-term consequences of cancer and its treatment (Actions 29 and 30).
Action 29 focuses primarily on survivorship and care after treatment, while Action 30 takes a broader approach to incorporating patients’ experiences, preferences and needs throughout the cancer-care pathway.
This includes aspects of daily life that extend beyond clinical outcomes, such as physical functioning, emotional well-being, autonomy, family relationships, work and social participation. (health.belgium.be)
Living with metastatic cancer on continuous treatment
While the plan addresses survivorship and patient-centred care, greater attention is needed for people living long-term with metastatic cancer who remain on continuous treatment.
Their needs may differ from those of patients who have completed treatment.
Long-term side effects, cognitive changes, fatigue, emotional well-being and the challenge of balancing treatment with work and family life must also be recognised.
For people receiving ALK-targeted therapies, managing these challenges is an important part of maintaining quality of life.
ALK Positive Belgium believes that people living with metastatic but controlled cancer should be included in the development and evaluation of future supportive-care pathways.
Their experiences can help ensure that improvements in cancer survival are accompanied by meaningful improvements in everyday life.
From Policy to Patient Access
Belgium’s National Cancer Plan provides an important framework for improving cancer care over the next decade.
However, its impact will depend on how the proposed actions are funded, implemented and evaluated.
ALK Positive Belgium will pay particular attention to:
- Molecular testing: Ensuring timely and equitable access to comprehensive biomarker testing, including appropriate testing when treatment resistance develops.
- Liquid biopsy and ctDNA: Following developments in reimbursement and supporting evidence-based research into molecular residual disease and serial molecular monitoring.
- Specialised cancer care: Improving access to molecular expertise, specialised lung cancer services and the National Molecular Tumour Board.
- Innovative treatments: Supporting access to targeted therapies, clinical trials and appropriate early-access pathways.
- Early diagnosis: Raising awareness of lung cancer in younger people and never-smokers, alongside evidence-based approaches to screening.
- Quality of life: Ensuring that people living with advanced cancer on long-term treatment are represented in supportive-care planning and patient-centred research.
Our commitment
At ALK Positive Belgium, we believe that progress in precision oncology must translate into meaningful improvements for patients.
Our priority is to ensure timely, equitable access to appropriate molecular testing, specialist expertise and effective treatments for people living with ALK-positive lung cancer across Belgium.
We will continue to follow the implementation of the National Cancer Plan, engage with relevant stakeholders and contribute the perspectives of people living with ALK-positive lung cancer.
The next step is turning policy commitments into meaningful improvements in patient care.
Sources
Belgian Cancer Plan 2026–2036
Federal Public Service Health, Food Chain Safety and Environment (SPF Santé publique / FOD Volksgezondheid), October 2026.
Official documents:
- Full National Cancer Plan — French (122 pages, PDF)
- Full National Cancer Plan — Dutch (119 pages, PDF)
- Short summary — French (PDF)
- Official government announcement — French
The article refers to Actions 5, 7, 8, 19, 23, 25, 28, 29 and 30 of the National Cancer Plan.