LAUSR

Introduction Precision oncology aims to customize targeted cancer therapies to the patient’s specific cancer molecular aberration(s). Evaluating a patient’s tumor molecular profile with next generation sequencing and other modern technologies to identify actionable abnormalities for matching with targeted agents provides an opportunity to personalize and impact cancer medicine at an individual and population level. Since the discovery of imatinib (GleevecVR ) for the treatment of BCRABL-driven chronic myelogenous leukemia and c-KIT mutant gastrointestinal stromal tumors, multiple monoclonal antibodies and small molecules have achieved regulatory approval and are now standard-of-care therapeutic options for patients, thus providing proof-of-concept for this approach. Trastuzumab for Her2/neu positive breast cancer, crizotinib for ALK and ROS1 rearranged non-small-cell lung cancer, as well as BRAF and MEK inhibitors for BRAF V600 mutant melanoma are a few examples, which have altered the therapeutic landscape of the oncology field. The development and incorporation of next generation sequencing clinical programs in academic institutions and commercial entities have permitted the conduct of multiple early studies of precision oncology in the western world. These clinical trials have specifically tested the precision medicine hypothesis by evaluating the clinical benefit of molecularly matched therapies in patients with different advanced cancers (Table 1). Collectively, these data have generally reflected the western population, as the studies have mainly been conducted in North America and Europe. A major issue that remains to be addressed is the likely geographical variability and prevalence of the varying actionable tumor molecular profiles in Asia compared to the West. This may impact the appropriate matching of patients with suitable therapies, trial accrual and the ultimate success of precision medicine programs. A prime example is that sensitizing EGFR mutations are much more prevalent in Asian populations compared to western ones. Another major challenge of precision oncology is that it may ultimately not be a feasible strategy to implement effectively and widely across Asia because of the current variability of established healthcare infrastructure, funding, critical mass of necessary expertise and political climate.