Molecular testing in gynecologic cancers is reshaping treatment decisions, expanding immunotherapy options for advanced endometrial cancer, and driving personalized maintenance care. However, professional surveys reveal significant barriers in Latin America, where next-generation sequencing and biomarker uptake remain limited by infrastructure gaps and testing send-out rates.
Molecular Testing and Regional Gaps in Latin American Endometrial Care
A cross-sectional survey of 679 oncology professionals across Argentina, Brazil, Colombia, and Mexico highlights a stark divide between the availability of advanced molecular assays and their actual integration into clinical decisions. The evaluation captured responses from 506 endometrial cancer specialists, representing a 74.5% completion rate for disease-specific items administered through the Research Electronic Data Capture platform between March and August 2025.
While standard biomarker testing was ordered by 54.7% to 84.7% of respondents depending on the country group, in-house technical capacity remained low. In-house next-generation sequencing and POLE testing were available to just 17.2% and 18.0% of respondents, respectively. Centers relied heavily on external laboratories, producing somatic next-generation sequencing send-out rates of 49.3% in Argentina and 62.9% in Colombia.
Treatment Access and Delays Across Country Groups
The survey uncovered a measurable gap between biomarker results and subsequent therapeutic application. Only 28.0% to 58.2% of respondents across the four countries reported they would add immunotherapy for advanced mismatch repair-deficient or microsatellite instability-high disease. Similarly, human epidermal growth factor receptor 2-directed therapy for positive advanced cases would be added by 29.3% to 54.9% of clinicians.
Access to immunotherapy and lenvatinib proved more heterogeneous and restricted than standard treatments. Compounding these biomarker and therapy bottlenecks, primary treatment initiation delays most commonly spanned 28 days to 3 months. A substantial proportion of cases experienced delays exceeding three months, peaking in Mexico at 21.3% of respondents.
Personalized Maintenance and Immunotherapy Shifts in Gynecologic Malignancies
On a broader clinical level, molecular diagnostics are redefining the standard approach to gynecologic cancers by moving treatment away from pure anatomic staging toward individualized biologic profiling. Molecular testing helps identify ovarian cancer patients who benefit from targeted maintenance therapies. While initial surgical decisions continue to depend on patient status and disease burden rather than genetic markers, molecular profiling directly governs postoperative maintenance choices and recurrent-setting management with targeted agents.
In uterine cancer, the last few years brought a distinct uptake in immunotherapy use driven by molecular targets, alongside the de-escalation of certain intensive therapies based on specific biomarker findings.