Precision Oncology & Genetic Testing: The New Era of Cancer Treatment in India.

Cancer treatment has changed significantly over the past two decades. While treatment decisions were traditionally based largely on the type, location, and stage of cancer, advances in molecular testing now allow oncologists to examine specific genetic and molecular characteristics of a tumor.

Precision oncology uses this information, along with a patient's clinical condition and other diagnostic findings, to help guide treatment decisions. For some cancers, identifying specific biomarkers or genetic alterations may help determine whether targeted therapy, immunotherapy, or another treatment approach could be appropriate.

Understanding precision oncology

Precision oncology is not about ordering more tests for every patient. It is about selecting appropriate molecular or genetic tests when the results may help guide treatment decisions. Cancer cells can develop specific genetic alterations or biomarkers that influence how a tumor grows and how it may respond to certain treatments.

For example, identifying an EGFR alteration in certain lung cancers can help determine whether an EGFR-targeted therapy may be appropriate. Similarly, BRCA1 or BRCA2 alterations can be relevant to treatment decisions in certain cancers, including breast, ovarian, pancreatic, and prostate cancers. However, finding a genetic alteration does not automatically mean that a targeted treatment will be suitable; the result must be interpreted in the context of the cancer type, stage, previous treatment, and the patient's overall clinical condition.

Precision Oncology in India: Opportunities and Challenges

In India, precision oncology offers significant opportunities, but access, affordability, and appropriate use remain important considerations. Molecular testing, including next-generation sequencing (NGS), can provide valuable information in selected cancers, particularly when the results have the potential to influence treatment decisions.

However, not every patient with cancer requires extensive genomic testing. The choice of test should depend on factors such as the type and stage of cancer, available treatment options, previous therapies, and whether the result is likely to change clinical management. Cost can also be an important consideration for patients and families.

As molecular testing becomes more widely available in India, multidisciplinary molecular tumor boards can help oncologists, pathologists, genetic specialists, and other experts interpret complex results and determine whether identified alterations have meaningful treatment implications. The goal should be to use molecular testing when it can provide clinically useful information—not simply to perform more tests.

Beyond mutations: the bigger picture

Precision oncology involves more than identifying a genetic alteration and selecting a targeted medicine. Cancer can change over time, and different cancer cells within the same tumor may have different molecular characteristics. These differences can influence how a cancer responds to treatment and how resistance to treatment develops.

In selected situations, additional molecular testing may help oncologists understand these changes. Liquid biopsy, for example, analyzes tumor-related genetic material circulating in the blood and may provide useful information without requiring a traditional tissue biopsy in certain clinical settings.

However, molecular tests and liquid biopsies are not necessary or appropriate for every patient. Their value depends on the type of cancer, stage of disease, available treatments, previous therapies, and the specific clinical question being investigated. Testing is most useful when the result has the potential to influence a patient's treatment plan.

Building infrastructure and expertise

The effective use of precision oncology requires more than access to advanced testing. Molecular pathologists, medical oncologists, genetic specialists, laboratory professionals, and bioinformatics experts may all contribute to interpreting complex genomic information and translating it into meaningful clinical decisions.

In India, collaboration between hospitals, diagnostic laboratories, academic institutions, and research organizations is helping expand access to molecular diagnostics and precision cancer care. As more genomic data from Indian patients becomes available, it may also improve our understanding of cancer biology and treatment responses within the Indian population.

For patients, the most important consideration remains whether a particular molecular test can provide information that may meaningfully influence diagnosis, treatment selection, or future management.

When Should Cancer Patients Consider Genetic or Molecular Testing? Genetic or molecular testing may be considered in selected patients when the results could provide information relevant to treatment decisions. Depending on the cancer type and clinical situation, testing may help identify biomarkers or genetic alterations associated with targeted therapies, immunotherapy, inherited cancer risk, or eligibility for certain clinical trials.

The type of testing required can vary. Tumor molecular testing examines changes within the cancer itself, while germline genetic testing looks for inherited genetic changes that may also have implications for family members. These tests answer different questions and should not be considered interchangeable.

Whether testing is appropriate depends on factors such as the type and stage of cancer, family history, previous treatments, available therapies, and current clinical guidelines. Patients should discuss the potential benefits, limitations, costs, and possible implications of testing with their oncologist or an appropriately qualified genetics professional before proceeding.

The take-home message

Precision oncology is becoming an increasingly important part of modern cancer care, but its value depends on using the right test for the right patient at the right time. Molecular and genetic testing may help identify biomarkers or alterations that can guide treatment decisions in selected cancers, but testing does not guarantee that a targeted treatment will be available or appropriate.

Patients considering molecular or genetic testing should discuss with their oncologist what the test is designed to identify, whether the result could change their treatment plan, the limitations of the test, and the potential costs involved.

As precision oncology continues to develop in India, thoughtful interpretation of molecular information alongside established clinical evidence will remain essential to providing personalized and responsible cancer care. Considering precision oncology or genetic testing as part of cancer treatment? Consult Dr. Amol Akhade to understand whether molecular testing may be relevant to your individual diagnosis and treatment plan.

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By Dr. Amol Akhade, Medical Oncologist, Fortis Hospital Mumbai – specializing in precision oncology, clinical research, and digital education in cancer care.