Molecular Profiling and Precision Oncology for Non–Small Cell Lung Cancer in Latin America: Unique Epidemiology, Persistent Barriers, and Paths Toward Equity

ABSTRACT Non–small cell lung cancer (NSCLC) represents a critical public health crisis in Latin America (LA), the leading cause of cancer-associated mortality across the region. Although global incidence rates are shifting, the burden in low- and middle-income countries is projected to increase significantly by 2030. Beyond the impact of tobacco, LA faces unique challenges derived from environmental exposures and diverse genetic ancestry that shape a molecular landscape distinct from other regions. This has resulted in a high prevalence of actionable drivers, particularly EGFR mutations, positioning a large segment of the population as ideal candidates for precision medicine approaches. However, current efforts to address this epidemic fall short of regional needs, as the potential of precision oncology remains largely unrealized due to multilevel systemic and economic barriers. Despite the scientific potential of targeted therapies to drastically improve survival, LA has not broadly or expeditiously adopted these strategies. A profound implementation gap is characterized by a reliance on inefficient single-gene testing, fragmented regulatory frameworks, and severe infrastructural limitations. Consequently, only a minimal proportion of the regional patient population benefits from recent advances, whereas the majority continue to receive empirical chemotherapy with significantly inferior survival outcomes. Addressing these disparities requires a steadfast focus on systemic transformation, ranging from establishing centralized genomic hubs to implementing structured educational programs. Standardizing care through molecular tumor boards (MTBs) and harmonizing regulatory pathways are essential steps in translating research into clinical benefits. In this review, we discuss the unique molecular epidemiology of the region and the challenges of treatment implementation, focusing on the urgent need to integrate new technologies to ensure equitable access to precision oncology. LA has one of the highest potential population-level benefits from precision oncology in NSCLC; however, systemic barriers prevent this molecular opportunity from translating into equitable survival gains (Graphical abstract).