Barriers and challenges for precision medicine and evidence-based oncology in genitourinary tumors in Latin America: insights from the LACOG 1024 survey CIELO.

Abstract

e23041 Background: Precision medicine and evidence-based oncology are cornerstones of modern cancer care, enabling personalized treatment strategies. However, resource disparities and heterogeneous healthcare systems may hinder the implementation of these approaches in Latin America (LATAM). To assess the impact of these barriers, we conducted a survey to describe the access to advanced diagnostic tools and FDA/EMA-approved therapies for genitourinary malignancies in Latin LATAM. Methods: The survey was distributed by the Genitourinary Group of the Latin American Cooperative Oncology Group (LACOG) among LATAM oncologists via Google Forms from September to December 2024. Access to key diagnostic and novel therapies was assessed through a 55-question electronic questionnaire targeting healthcare providers across the region. Results: Among 131 participants from 11 LATAM countries, 84.8% were clinical oncologists, 13% worked solely with public coverage, 36.6% with private, and 50.4% with both. Access to key diagnostics covered by the majority of health insurance providers ( > 50 %) included PSMA PET/CT scans for early stage prostate cancer (PC, 48.1%), MRI-fusion prostate biopsy (30.5%), transperineal prostate biopsy (39.7%), hereditary counseling for PC (31.3%), and germline testing for PC (21.4%). Somatic testing for PC was predominantly available through industry-sponsored programs (59.5%) and financial costs were cited as the primary barrier to testing (77.1% reported as the main barrier for somatic genomic tests and 85.5% for genomic risk platforms). Regarding access to therapies, 48.1% of the participants had access to adjuvant pembrolizumab for renal cell carcinoma, 42.7% to olaparib monotherapy for PC, 41.2% to enzalutamide for non-metastatic castration-sensitive PC, 38.2% to adjuvant nivolumab for urothelial carcinoma, and 31.3% to pembrolizumab for non-muscle invasive bladder cancer. Conversely, treatments such as first-line enfortumab vedotin with pembrolizumab (18.3%), erdafitinib (18.3%), Lu 177 vipivotide tetraxetan (9.9%), relugolix (6.9%), and belzutifan (1.5%) faced significant access barriers. Conclusions: To the best of our knowledge, this is the largest survey conducted on this topic to date in LATAM. The results underscore substantial barriers to the adoption of precision medicine, driven predominantly by limited insurance coverage and financial constraints. Enhancing access to advanced diagnostics and therapies is crucial for bringing regional practices in line with global standards and for improving patient outcomes. Collaborative efforts and policy interventions are critical for addressing these disparities. Data from the CIELO Survey will inform future initiatives by LACOG-GU ambassadors aiming to reduce healthcare inequities in LATAM.