Precision Oncology in India: How Tumor Sequencing Is Changing Treatment
In India, precision oncology is reshaping treatments by utilizing tumor sequencing.Tumor sequencing is transforming treatments in India through Precision Oncology. Every year India witnesses approximately 1.56 lakh new cancer cases. Throughout much of that history treatment has been based on a single principle: recognize the organ, stick to the protocol. Chemotherapy, radiation, surgery. Same tools, same method, whatever was powering the cancer, on the cellular level. This is a change in logic. New techniques called tumor sequencing are allowing doctors to sequence and read the genetic code of a tumor, so that each patient can be matched with a treatment that was designed specifically for their tumor's genes. This is known as precision oncology and is gradually revolutionizing cancer treatment in India.
What is Tumour sequencing?
All cancers are ultimately caused by errors in the DNA. Certain mutations are passed down through the generations. The majority are lifetime accumulations. What's important in the clinic is that the various mutations promote different aspects of tumor cell growth and many of these mutations are now the substrate for specific drugs. Tumor sequencing involves the analysis of DNA found in a patient's tumor sample, usually done by a technology called Next-Generation Sequencing (NGS). It uncovers genes with mutations, proteins that are over-expressed and molecular pathways that are in operation. An NGS panel is a panel that tests 50 or more genes at one time. CGP can test for 300+ genes in one test. The output is more than just a list of mutations. It's a map: it tells you which therapies will most likely work, which clinical trials you might be able to participate in, and which drugs are unlikely to be of any benefit to you.
Why It Matters More in India
Cancer genomes of the Indian population vary significantly from those of other Western countries. In a large study of 5,219 lung cancer patients from India, researchers in the Journal of Precision Oncology of ASCO reported that 80.6% of them had detectable genomic alterations, and 64.2% of the patients had mutations that are actionable and for which there are FDA-approved targeted therapies available. For instance, the incidence of EGFR mutations is higher (∼32%) among Indian non-small cell lung cancer (NSCLC) patients compared to those in Western countries. This is reflected on the survival numbers. In reality, Indian data indicates the median overall survival in patients who were diagnosed with driver mutations and treated with NGS matched targeted therapy was 26.7 months, while in patients who did not have driver mutations, the median overall survival was 9.3 months. This also led to a doubling of median PFS from 6 to 12 months with first-line NGS-guided treatment in NSCLC.
Where India Stands Today
The oncology NGS market size in India grew from USD 22.01 million in 2024 to USD 33.45 million by 2030. Adoption is picking up pace, but uneven adoption. Top cancer hospitals have taken a proactive stance. In January 2024, Apollo Cancer Centres opened India's first Artificial Intelligence (AI) – Precision Oncology Centre in Bengaluru, where genomic profiles are matched with targeted therapies. Tata Memorial Hospital, Mumbai, has a research wing called ACTREC, which is a leader in the country for advanced molecular profiling and is the coordinating centre of the National Cancer Grid, which aims to standardise the precision protocols in over 300 centres. There are also structured genomic testing programs currently underway at AIIMS New Delhi, Medanta, Max Healthcare and Rajiv Gandhi Cancer Institute. Public sector access is still being restricted, though. A multi-center study found only 16% of eligible patients in all cancer types – except for lung or ovarian – were tested using the multigene panel. In the few who were diagnosed with actionable mutations, only about 7% were able to get the targeted therapy they were recommended. One of the major obstacles is cost. The range of a comprehensive genomic profile is between ₹1 lakh and ₹2.2 lakh. Coverage of genomic sequencing is still in its nascent stage in India. There is some progress, but access must catch up to capability.
How This Affects Patients and Families
Here is what it is like to actually get the diagnosis of Cancer – and what that means when you or a loved one is diagnosed with it today. Ask your cancer specialist if genomic testing is right for your cancer. It is well established for lung, breast, colorectal, ovarian, and some blood cancers and is growing in momentum. Testing involves collecting a tissue sample from a biopsy or surgery or in some cases an "old" sample from a blood draw. The results should take 2-3 weeks and are reviewed by a multidisciplinary tumour board comprised of oncologists, pathologists and geneticists who look at your results within the context of your overall clinical history. This is not meant to replace the judgement of your oncologist. It's to provide them with more information. Not all tumors will have a "finding" that has an "action" associated with it. However, for those who do, the difference in the direction of treatment, as well as treatment outcomes, can be great.
Frequently Asked Questions
1. Are tumor tests the same as hereditary cancer tests?
No. Hereditary genetic testing (e.g. breast and ovarian cancer testing for BRCA mutations) is used to detect mutations you were born with that you can pass on to your children. Tumor sequencing involves the sequencing of mutations that are present only in the cancer cells themselves. Both are clinically useful but ask different questions.
2. What are the cancer types that can be best benefited from tumor sequencing in India?
The most compelling evidence for the role of NGS in supporting treatment decisions is for lung, breast, colorectal, and ovarian cancers and some leukemias.
3. The cost of tumour test in India and the insurance coverage?
Costs range widely. A focused single-gene test may cost ₹10,000 to ₹30,000. A standard NGS panel runs ₹35,000 to ₹50,000. The price range of comprehensive genomic profiling (300+ genes) is between ₹1 lakh to ₹2.2 lakh. Limited but increasing insurance coverage available for genomic testing.
4. What if a mutation is not found any further action to be taken?
Test results that are negative have actionable value. It can help oncologists plan treatment, by ruling out therapies unlikely to be effective, may help identify eligibility for immunotherapy (by PD-L1 or TMB), and may help identify clinical trials that would be available.
5. Does it contain liquid biopsy?
Yes, liquid biopsy identifies tumor DNA that is circulating in the blood. It is useful when a tissue biopsy is not possible or when the monitoring of treatment is required over time.
6. Is sequencing of tumors a prerogative of only big cities in India?
Metropolitan cities such as Mumbai, Delhi, Bengaluru, Chennai and Hyderabad have the highest availability. But samples from many tier-2 cities can be sent to a reference lab and the National Cancer Grid is actively trying to increase the network of centres with a standardised protocol. Patients in smaller cities can also have a telemedicine consultation with a precision oncology specialist.
References
1. Ramalingam, S. and others. "Genomic landscape of Indian non-small cell lung cancer patients. Journal of the ASCO. 2024. ascopubs.org/doi/full/10.1200/PO.24.00155
2. This article is titled: "Clinical Utility of NGS in Advanced NSCLC: Real-World Evidence from India. PubMed Central / NCBI. 2025. ncbi.nlm.nih.gov/pmc/articles/PMC12311926
3. India Oncology Next-Generation Sequencing (NGS) Market Report. TechSci Research. 2024. techsciresearch.com/report/india-oncology-ngs-market/20945.html
