Precision Oncology in Resource-Constrained Settings: Challenges and Ethical Dilemmas in Low- and Middle-Income Countries

Abstract

Human genomes have been explored in an elaborate fashion. However, the road to understanding genomics-guided treatment is still in its infancy. Genome-wide sequencing studies have identified genetic variants and somatic mutations that lead to cancer. Precision oncology uses genomic and molecular information to guide individualised therapeutic strategies tailored to each cancer patient. This approach requires distinguishing somatic tumour profiling from germline testing, as their implications for consent, disclosure, confidentiality and the identification of inherited cancer susceptibility differ. The stark contrast in the application of precision cancer medicine (PCM) in low- and middle-income countries (LMICs) versus high-income countries (HICs) has led to difficulty in adopting this concept and, in the long run, the application. PCM is of paramount importance for achieving therapeutic evidence for cancer by analysing and creating molecular targets for specific genes. Although this emerging field is progressively becoming a footprint of medical oncology, many challenges still exist that could hinder the success of precision oncology in LMICs. The disparity in the introduction of precision oncology in LMICs needs a different approach, considering the structural, ethical, socioeconomic and cultural barriers.