Jung, a man in his 70s, was diagnosed with colorectal cancer at Korea University Guro Hospital in 2021 and underwent surgery and chemotherapy for about five years. He actively pursued treatment through first- and second-line chemotherapy, but as the cancer progressed again, he faced the need for later-stage treatment beyond the third line.
Drugs that could be used for treatment still remained. However, because health insurance did not apply, the patient had to bear drug costs of several million won per month himself. Jung wanted to continue treatment but ultimately stopped, worried about the financial burden it could place on his family. "I felt great despair at the reality of having to give up treatment because of cost, even though there was a drug to treat me," Jung said. "I hope national support will be expanded so that no patient stops chemotherapy for economic reasons."
Metastatic colorectal cancer patients are being pushed toward a so-called "reimbursement cliff" after completing first- and second-line chemotherapy. Although treatments that can be used beyond the third line exist, many fall outside health insurance coverage, meaning whether treatment continues depends on the patient's financial means.
Professor Oh Sang-cheol of the Division of Oncology at Korea University Guro Hospital, a "metastatic colorectal cancer authority," said, "Compared with other cancer types, many metastatic colorectal cancer patients remain in good overall condition even after completing first- and second-line treatment, so survival extension can be expected through third-line treatment." He added, "Treatment opportunities must be guaranteed so that drugs with confirmed efficacy can be used to the end."
On Seoul Economic Daily TV's "Now, the Authority," airing at 9 p.m. on the 18th, Professor Oh Sang-cheol, a "metastatic colorectal cancer authority," appears to explain treatment strategies for metastatic colorectal cancer and the need for insurance reimbursement of chemotherapy beyond the third line.
◇ One in Five Colorectal Cancer Patients Diagnosed With 'Metastatic Colorectal Cancer'
Metastatic colorectal cancer is a state in which the cancer has spread beyond the colon to other organs such as the liver, lungs, or peritoneum, and is classified as stage 4 colorectal cancer.
About 20% of all colorectal cancer patients are found to have already metastasized to other organs at the time of initial diagnosis. When metastasis occurs, survival rates also drop significantly. The five-year relative survival rate for colorectal cancer from 2019 to 2023 was around 80-90% when the cancer was confined to the organ of origin or had invaded only surrounding tissue, but it falls to 20.4% when distant metastasis occurs.
Metastatic colorectal cancer mainly spreads to the liver, lungs, and peritoneum, and rarely to the bones, brain, or skin. However, unlike other cancers, experts explain that long-term survival can be expected even when metastasis has occurred if surgery and chemotherapy are appropriately combined.
About 20% of metastatic colorectal cancer patients can undergo surgery from the outset. Even if surgery is difficult immediately, some patients proceed to surgery after chemotherapy reduces the size and number of tumors. "About 20-30% of patients initially judged difficult to operate on undergo surgery after chemotherapy," Professor Oh said. "Even if metastasis has occurred to other organs, we actively consider surgery if the cancer can be removed while maintaining organ function."
◇ Patients in Good Condition Even After First and Second-Line Treatment... No Reimbursement From Third Line
Chemotherapy for metastatic colorectal cancer generally proceeds in the order of first-line, second-line, and beyond-third-line treatment. For patients beginning treatment for the first time, cytotoxic anticancer agents combined with targeted therapies or immunotherapies are used, considering genetic testing, the location of the cancer, and the extent of metastasis.
If the cancer grows or a new lesion appears during first-line treatment, it is judged that resistance to the drug has developed, and treatment is changed to second-line. In second-line treatment as well, anticancer agents and targeted therapies not used in the first line are combined to suppress cancer progression.
The problem comes after first- and second-line treatment ends. Currently in Korea, most first- and second-line treatment for metastatic colorectal cancer is covered by health insurance. In contrast, there are effectively no health insurance-covered options for treatment beyond the third line, so the patient's burden increases sharply. Several drugs, including fruquintinib, can be considered for later-stage treatment of metastatic colorectal cancer. But if health insurance does not apply, the patient must bear drug costs of several million won per month.
"When we recommend a drug whose efficacy is textbook-proven to a patient and actual treatment effects appear, the medical staff also feel a great sense of reward," Professor Oh said. "But if at some point we must stop treatment because there is no reimbursed drug, we come to wonder whether this is truly a system that places the patient's life at its center."
He stressed, "There are research results showing that the more sequentially and sufficiently a patient uses various treatments, the longer their survival period." He added, "The situation in which patients expected to benefit cannot use drugs for economic reasons alone must be improved."
The reimbursement gap for third-line drugs has also been raised by patient groups. In November 2025, the Korea Cancer Patients' Rights Council and a colorectal cancer patients' group filed an urgent petition with the National Human Rights Commission and the Anti-Corruption and Civil Rights Commission, arguing that colorectal cancer patients' right to life is being violated because they cannot access essential novel drugs from the third-line treatment stage.
The issue was also addressed at the 2025 National Assembly parliamentary audit. Democratic Party lawmaker Seo Mi-hwa questioned why domestic patients are excluded from access to novel drugs, unlike in major overseas countries where various third-line treatments are used. The Ministry of Health and Welfare stated its position that it would swiftly review reimbursement if an application for reimbursement of third-line colorectal cancer drugs is made in the future.
◇ Oral Novel Drug Emerges... Treatment Access Must Improve
Recently, new drugs that can be used for third-line treatment of metastatic colorectal cancer have also been introduced. Notably, fruquintinib, the main ingredient of Fruzaqla, is a targeted therapy that selectively inhibits the vascular endothelial growth factor receptors VEGFR 1, 2, and 3, blocking the formation of blood vessels that supply nutrients to cancer cells. As an oral drug, it improves treatment convenience for patients.
In clinical trials of metastatic colorectal cancer patients who had received prior treatment, the fruquintinib group showed improvements in overall survival and progression-free survival. In the interview, Professor Oh explained the relevant clinical results: "It showed an effect of reducing the risk of cancer death by about 35%, confirming a meaningful result as a later-stage treatment."
However, even if such drugs are approved, if insurance reimbursement does not apply, the options patients can actually use in clinical practice are inevitably limited.
"Korea has a universal health insurance system, so reimbursement effectively determines whether treatment is possible," Professor Oh said. "If it is difficult to apply the same out-of-pocket rate to all patients, various approaches such as partial cost support or tiered support also need to be considered."
Is metastatic colorectal cancer really untreatable? [Professor Oh Sang-cheol, Division of Oncology, Korea University Guro Hospital]
