Introduction

Cancer remains one of the leading causes of morbidity and mortality globally. Despite notable advances in systemic therapy, the prognosis for patients with advanced metastatic solid tumors continues to be poor, primarily due to the inability of conventional treatments - surgery, radiotherapy, and chemotherapy - to effectively target the molecular drivers of malignancy.

Recent advancements in cancer genomics have revolutionized oncology by enabling more precise and individualized therapeutic strategies. Among these innovations, next-generation sequencing (NGS) has emerged as a powerful tool for comprehensive molecular profiling. Unlike first-generation sequencing technologies, NGS allows for rapid, high-throughput analysis of entire genomes, exomes, or targeted gene panels, using either tumor tissue or circulating tumor DNA from blood samples [1].

The widespread adoption of NGS has provided invaluable insights into tumor biology and has enabled the identification of prognostic, diagnostic, and predictive biomarkers. Multiple studies have demonstrated the utility of NGS in detecting actionable driver mutations in various cancers, including lung, breast, and colorectal malignancies, leading to the successful implementation of targeted therapies that have improved patient outcomes [2,3].

In recognition of the growing relevance of molecular oncology, the European Society for Medical Oncology (ESMO) developed the ESMO Scale for Clinical Actionability of Molecular Targets (ESCAT), a systematic framework for classifying genomic alterations based on the strength of clinical evidence supporting targeted treatment [4]. While such frameworks support evidence-based application of NGS in clinical practice, their real-world implementation - especially in resource-constrained settings - remains variable and sometimes uncertain [5].

In high-income countries, NGS is increasingly integrated into routine oncology care, guiding treatment decisions for patients with advanced or refractory cancers. However, in low- and middle-income countries (LMICs), the clinical utility of NGS is still evolving. Challenges such as limited access to sequencing platforms, high costs, lack of reimbursement, and restricted availability of matched targeted therapies continue to impede its broader adoption [6].

In this study, we present real-world data from a single-center experience in an LMIC, evaluating the impact of NGS-guided treatment on clinical outcomes - specifically, progression-free survival (PFS) - in patients with advanced solid tumors.