Precision oncology in Latin America: current situation, challenges and perspectives

Abstract

Background Anti-cancer cytotoxic treatments like platinum-derived compounds often show low therapeutic efficacy, high-risk side effects and resistance. Hence, targeted treatments designed to attack only tumour cells avoiding these harmful side effects are highly needed in clinical practice. Due to this, precision oncology has arisen as an approach to specifically target alterations present only in cancer cells, minimising side effects for patients. It involves the use of molecular biomarkers present in each kind of tumour for diagnosis, prognosis and treatment. Since these biomarkers are specific for each cancer type, physicians use them to stratify, diagnose or take the best therapeutic options for each patient depending on the features of the specific tumour. Aim This review aims to describe the current situation, limitations, advantages and perspectives about precision oncology in Latin America. Main body For many years, many biomarkers have been used in a clinical setting in developed countries. However, in Latin American countries, their broad application has not been affordable partially due to financial and technical limitations associated with precarious health systems and poor access of low-income populations to quality health care. Furthermore, the genetic mixture in Latin American populations could generate differences in treatment responses from one population to another (pharmacoethnicity) and this should be evaluated before establishing precision therapy in particular populations. Some research groups in the region have done a lot of work in this field and these data should be taken as a starting point to establish networks oriented to finding clinically useful cancer biomarkers in Latin American populations. Conclusion Latin America must create policies allowing excluded populations to gain access to health systems and next generation anti-cancer drugs, i.e. high-cost targeted therapies to improve survival. Also, cancer clinical research must be oriented to establish cancer biomarkers adapted to specific populations with different ethnicity, allowing the improvement of patient outcomes.

Impact of the COVID-19 Pandemic on Oncology Clinical Research in Latin America (LACOG 0420)

“… 11 In Latin American countries, clinical trials are sometimes the only possibility for patients in the public health system to have access to optimal standard-of-care treatments and/or innovative targeted therapies or immunotherapy. 12 - 14 Clinical research may be one of the most affected oncology areas during the pandemic, mostly because of the need for frequent in-person visits to the research sites and consequently, more exposure to COVID-19. 15 At the same time, staff who face patients directly, including research staff in institutions participating in clinical trials, are at higher risk of SARS-CoV-2 infection.…”

Fighting Cancer around the World: A Framework for Action

“…The cancer incidence in Latin America (LATAM) is low, but mortality is high, and forecasts are for a 35% increase in cases by 2030 in South America and 42% in Mexico [ 73 ]. In 2020, the region saw more than 1.4 million new cases and more than 600,000 deaths.…”

Mutational Landscape and Actionable Target Rates on Advanced Stage Refractory Cancer Patients: A Multicenter Chilean Experience

“…As an example, the high frequency of ESR1 in our cohort versus TCGA is probably due to the inclusion of a patient with luminal tumors (ER+) who received hormone therapy, and therefore represents a selection bias. Previously, other authors have analyzed the main obstacles to the implementation of precision medicine programs in the region; these are mainly related to high costs and limited (or lack of) access to health coverage [31]. These studies also emphasize the need for locally generated data.…”