Molecular Profiling in Asia: The Current Status and Approach

Precision oncology has transformed cancer care globally through biomarker-driven and genomically guided treatment strategies. In Asia, where nearly 60% of the world's population resides, the implementation of molecular profiling presents both significant opportunities and unique challenges. Despite increasing adoption, precision diagnostics remain largely concentrated in urban and academic centers, with disparities in access, infrastructure, and expertise across the region. Advances in next-generation sequencing (NGS), including targeted gene panels, comprehensive genomic profiling, whole exome sequencing, and whole-genome sequencing, have enabled the identification of actionable alterations across multiple tumor types. Liquid biopsy approaches, including circulating tumor DNA (ctDNA) and circulating tumor cells (CTCs), are further transforming cancer care by enabling real-time disease monitoring and detection of resistance mechanisms. Integration of multiomics platforms is increasingly enhancing clinical decision-making. Molecular tumor boards play a critical role in interpreting complex genomic data and facilitating genomically guided treatment decisions, including targeted therapy selection, off-label treatment recommendations, and clinical trial enrollment. However, several barriers continue to limit widespread implementation of genetic testing in Asia, including high costs, limited reimbursement, inadequate infrastructure, lack of trained personnel, and insufficient genomic databases representing Asian populations. This review provides a comprehensive overview of current molecular diagnostic approaches, clinical applications, and evolving precision oncology practices in Asia. We also highlight key challenges and propose practical solutions, including physician and patient education, expansion of trial-matching platforms, and development of region-specific genomic datasets. Strengthening these areas will be essential for advancing equitable, accessible, and effective precision cancer care across Asia.