Making sense of commercial genomic reports in oncology: a structured approach from clinical practice.

Background: Commercial genomic profiling is increasingly used in oncology practice, yet translating reported alterations into treatment decisions remains challenging. Differences across assays, variable evidence levels, and limited access to molecular tumor boards mean that interpretation often depends on the treating clinician rather than the report alone. Perspective: We describe a structured clinical approach to interpreting commercially generated genomic reports in routine oncology practice using curated public genomic resources, targeted literature review, and clinical feasibility assessment. This approach was developed in a private oncology practice in Jordan to support treatment decisions when formal molecular tumor board access is limited. Illustrative application: Two clinical scenarios demonstrate both consideration of targeted therapy in the setting of a biologically plausible but weakly annotated alteration and recognition of non-actionability when genomic findings do not justify deviation from disease-specific management. Conclusion: Structured interpretation can support more consistent clinical decision making around genomic findings, particularly when molecular tumor boards are not readily available. It may help bridge the gap between access to sequencing and meaningful clinical application in routine oncology practice.