Landscape of cancer genomics and precision oncology in Japan, South Korea, China, and Australia.

Precision oncology has expanded rapidly across the Asia-Pacific region, yet implementation remains heterogeneous because of differences in health-system organisation, reimbursement, molecular tumour board infrastructure, workforce capacity, and data integration. This structured narrative review with expert consultation compares precision oncology ecosystems in Japan, South Korea, China, and Australia to identify common challenges and implementation strategies across the patient pathway. Although each country has established distinctive genomic medicine programmes, major disparities persist in access to comprehensive genomic profiling, molecularly matched therapies, and longitudinal data infrastructure. Comparative analysis highlights that successful implementation depends not only on sequencing capacity but also on coordinated governance, reimbursement alignment, multidisciplinary decision-making, research integration, and equitable access. Particular attention is required for geographically underserved populations and patients with rare or paediatric cancers. Based on these findings, we propose seven prioritised policy recommendations to strengthen precision oncology implementation, emphasising regional collaboration, interoperable data systems, workforce development, and sustainable reimbursement strategies to improve equity and clinical impact across the Asia-Pacific region.