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| Journal Article (Review Article) | DKFZ-2026-01315 |
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2026
American Society of Clinical Oncology
Alexandria, Va.
Abstract: Cancer treatment is evolving from organ-based classification toward biomarker-driven precision medicine, culminating in the development of tumor-agnostic therapies approved based on molecular characteristics, irrespective of tumor origin. Since the US Food and Drug Administration's landmark 2017 approval of pembrolizumab for microsatellite instability-high tumors, nine tumor-agnostic drugs have been approved, offering unprecedented treatment options for patients with rare cancers and actionable genomic alterations. However, this scientific breakthrough has revealed profound global implementation challenges. We reviewed the current landscape of tumor-agnostic drug approvals, regulatory pathways, and implementation experiences across multiple regions, including Europe, Asia-Pacific, Latin America, Africa, and the Middle East. Barriers to access were examined across regulatory, reimbursement, infrastructure, and workforce domains to inform a conceptual framework for implementation. Access remains inconsistent even in high-resource settings, with fewer than 50% of eligible patients receiving matched therapies. In Europe, centralized regulatory approval through the European Medicines Agency contrasts sharply with fragmented national reimbursement decisions, creating delays in access. Asia-Pacific nations demonstrate rapid growth in tumor-agnostic approvals and drug development capacity, although significant urban-rural disparities persist. Latin America, Africa, and areas in the Middle East face fundamental barriers, including limited testing infrastructure, workforce shortages, and competing health care priorities. To address these challenges, we propose a four-pillar framework for equitable implementation: comprehensive biomarker testing capability, innovative clinical trial designs with decision-support systems, harmonized regulatory approval and reimbursement mechanisms, and investment in genomically competent workforce development. International initiatives including Project Orbis and cross-border trial consortia demonstrate promising models for regulatory convergence. Realizing the transformative potential of tumor-agnostic therapies requires coordinated global strategies that bridge the divide between genomic innovation and geographic accessibility, ensuring all patients benefit regardless of socioeconomic status or location.
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