{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T15:20:55Z","timestamp":1790349655589,"version":"4.1.0"},"reference-count":39,"publisher":"Open Exploration Publishing","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Explor Target Antitumor Ther"],"accepted":{"date-parts":[[2026,6,21]]},"abstract":"<jats:p xml:lang=\"en\">Precision oncology has revolutionized cancer care in high-income countries, but its implementation in Latin American low-resource settings faces profound bioethical dilemmas. This study analyzes these challenges through the lens of social justice and equity. An integrative review was conducted following the Whittemore and Knafl framework. A systematic search was performed across PubMed, Scopus, SciELO, and LILACS (2015\u20132025). Thematic synthesis was applied to integrate empirical data with normative bioethical theories. Four major analytical themes were identified: 1) The innovation paradox and financial toxicity, where prohibitive pricing (exceeding 100,000 USD\/year) violates distributive justice and leads to a biological penalty in survival; 2) Infrastructure deficits and epistemic injustice, highlighted by a 9.4% access rate to next-generation sequencing (NGS) and the risks of applying Eurocentric genomic data to admixed LA populations; 3) Research vulnerability, where clinical trials serve as survival strategies, compromising autonomy and informed consent; and 4) The judicialization dilemma, where individual court orders for high-cost drugs threaten systemic sustainability and equity. To prevent a genomic apartheid, Latin America must transition toward genomic sovereignty and frugal precision oncology. Bioethical frameworks in the region must prioritize protection ethics and social justice to ensure that scientific innovation does not exacerbate existing health inequities.<\/jats:p>","DOI":"10.37349\/etat.2026.1002397","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T02:33:08Z","timestamp":1786415588000},"update-policy":"https:\/\/doi.org\/10.37349\/open_exploration_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Bioethical challenges in the implementation of targeted anti-tumor therapies in low-resource settings: a perspective from Latin America"],"prefix":"10.37349","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5824-9867","authenticated-orcid":false,"given":"Alcides","family":"Chaux","sequence":"first","affiliation":[{"name":"Facultad de Ciencias de la Salud, Universidad Central del Paraguay, Ciudad del Este 7000, Paraguay; ChauxLab Institute, Asunci\u00f3n 1230, Paraguay"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"21850","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1007\/s12687-015-0217-5","article-title":"Ethical issues in genetics and public health in Latin America with a focus on Argentina","volume":"6","author":"Penchaszadeh","year":"2015","journal-title":"J Community Genet"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.3332\/ecancer.2019.898","article-title":"Access to high-cost drugs for advanced breast cancer in Latin America, particularly trastuzumab","volume":"13","author":"Barrios","year":"2019","journal-title":"Ecancermedicalscience"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3322\/caac.21696","article-title":"The burden of lung cancer in Latin-America and challenges in the access to genomic profiling, immunotherapy and targeted treatments","volume":"119","author":"Raez","year":"2018","journal-title":"Lung Cancer"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.3332\/ecancer.2024.1653","article-title":"Implementing precision oncology in Latin America to improve patient outcomes: the status quo and a call to action for key stakeholders and decision-makers","volume":"18","author":"de Castilla","year":"2024","journal-title":"Ecancermedicalscience"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1329024","article-title":"Next-generation sequencing for pediatric CNS tumors: does it add value in a middle-income country setup?","volume":"14","author":"Amayiri","year":"2024","journal-title":"Front Oncol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1038\/538161a","article-title":"Genomics is failing on diversity","volume":"538","author":"Popejoy","year":"2016","journal-title":"Nature"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1038\/s41416-020-01038-6","article-title":"Cancer health disparities in racial\/ethnic minorities in the United States","volume":"124","author":"Zavala","year":"2020","journal-title":"Br J Cancer"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1200\/go.20.00663","article-title":"Post-trial obligations in the Declaration of Helsinki 2013: classification, reconstruction and interpretation","volume":"16","author":"Mastroleo","year":"2016","journal-title":"Dev World Bioeth"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1186\/s13059-016-0914-3","article-title":"The ethics of sustainable genomic research in Africa","volume":"17","author":"Parker","year":"2016","journal-title":"Genome Biol"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-019-0961-y","article-title":"Is the judicialization of health care bad for equity? A scoping review","volume":"18","author":"Andia","year":"2019","journal-title":"Int J Equity Health"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.52214\/vib.v9i.10310","article-title":"Comparative Ethics of Modern Payment Models","volume":"9","author":"Riegler","year":"2023","journal-title":"Voices Bioeth"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1111\/j.1365-2648.2005.03621.x","article-title":"The integrative review: updated methodology","volume":"52","author":"Whittemore","year":"2005","journal-title":"J Adv Nurs"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"285","DOI":"10.3233\/EFI-180221","article-title":"The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers","volume":"34","author":"Hong","year":"2018","journal-title":"Educ Inf"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-8-45","article-title":"Methods for the thematic synthesis of qualitative research in systematic reviews","volume":"8","author":"Thomas","year":"2008","journal-title":"BMC Med Res Methodol"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.00110-21","article-title":"Copan eNAT Transport System To Address Challenges in COVID-19 Diagnostics in Regions with Limited Testing Access","volume":"59","author":"Richard-Greenblatt","year":"2021","journal-title":"J Clin Microbiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e1247","DOI":"10.1200\/op.21.00847","article-title":"Economic Cost and Sustainability of Oral Therapies in Precision Oncology","volume":"18","author":"Desai","year":"2022","journal-title":"JCO Oncol Pract"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"i49","DOI":"10.1093\/nop\/npae098","article-title":"Financial challenges of being on long-term, high-cost medications","volume":"12","author":"Elshiekh","year":"2024","journal-title":"Neurooncol Pract"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.3332\/ecancer.2025.1966","article-title":"Real World Outcomes with Tepotinib in a Series of Indian Patients with MET Exon 14 Skipping positive Non-Small Cell Lung Cancer","volume":"19","author":"Sebastian","year":"2025","journal-title":"Ecancermedicalscience"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0321187","article-title":"Dismal pathological response to neoadjuvant chemotherapy in stage III breast cancer patients in Tanzania: A retrospective review","volume":"20","author":"Kivuyo","year":"2025","journal-title":"PLOS One"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2023.1163391","article-title":"Real-world disparities and ethical considerations with access to CFTR modulator drugs: Mind the gap!","volume":"14","author":"Zampoli","year":"2023","journal-title":"Front Pharmacol"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noaf193.512","article-title":"P15.22.B unmasking socioeconomic inequities in Glioblastoma care: A systematic review of barriers to palliative and supportive services in Asia","volume":"27","author":"Putra","year":"2025","journal-title":"Neuro Oncol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1634\/theoncologist.2012-0279","article-title":"The Financial Toxicity of Cancer Treatment: A Pilot Study Assessing Out-of-Pocket Expenses and the Insured Cancer Patient's Experience","volume":"18","author":"Zafar","year":"2013","journal-title":"Oncologist"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1184","DOI":"10.6004\/jnccn.2019.7305","article-title":"Financial Burdens of Cancer Treatment: A Systematic Review of Risk Factors and Outcomes","volume":"17","author":"Smith","year":"2019","journal-title":"J Natl Compr Cancer Netw"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics14030287","article-title":"Somatic Mutations in Latin American Breast Cancer Patients: A Systematic Review and Meta-Analysis","volume":"14","author":"Mart\u00ednez-Nava","year":"2024","journal-title":"Diagnostics"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.3390\/jpm15110516","article-title":"The Three Musketeers in Cancer Therapy: Pharmacokinetics, Pharmacodynamics and Personalised Approach","volume":"15","author":"Zari\u0107","year":"2025","journal-title":"J Pers Med"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1111\/jmwh.12018","article-title":"Health Literacy and Women\u2019s Health: Challenges and Opportunities","volume":"58","author":"Corrarino","year":"2013","journal-title":"J Midwifery Womens Health"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1056\/nejmsa021212","article-title":"Readability Standards for Informed-Consent Forms as Compared with Actual Readability","volume":"348","author":"Paasche-Orlow","year":"2003","journal-title":"N Engl J Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1111\/jnu.12171","article-title":"Addressing the Challenges of Conducting Research in Developing Countries","volume":"47","author":"Amerson","year":"2015","journal-title":"J Nurs Scholarsh"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-022-01704-6","article-title":"Judicialization of health: profile of demands for oncological medicines in a state in the central region of Brazil","volume":"21","author":"Salha","year":"2022","journal-title":"Int J Equity Health"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1200\/po.21.00001","article-title":"Global Implementation of Precision Oncology","volume":"5","author":"Yam","year":"2021","journal-title":"JCO Precis Oncol"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1032300","article-title":"Addressing the unmet needs of patients with BRAF-mutated melanoma in Latin America: Expert perspective","volume":"13","author":"Salman","year":"2023","journal-title":"Front Oncol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.1080\/03007995.2019.1644851","article-title":"Availability of post-trial access in clinical trials: a review of clinical trial protocols submitted to the research ethics board of the University of the Philippines Manila","volume":"35","author":"Jimenez","year":"2019","journal-title":"Curr Med Res Opin"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1017\/gheg.2018.3","article-title":"Genomics research in Africa and its impact on global health: insights from African researchers","volume":"3","author":"Munung","year":"2018","journal-title":"Glob Health Epidemiol Genom"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"2711","DOI":"10.1038\/s41591-024-03225-x","article-title":"The WHO genomics program of work for equitable implementation of human genomics for global health","volume":"30","author":"Ambrosino","year":"2024","journal-title":"Nat Med"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1200\/go.20.00552","article-title":"Authorship Patterns in Cancer Genomics Publications Across Africa","volume":"7","author":"Rotimi","year":"2021","journal-title":"JCO Glob Oncol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"32","DOI":"10.3126\/hprospect.v10i0.5646","article-title":"Implication of Public Health Genomics for Low and Middle Income Countries","volume":"10","author":"Neupane","year":"2018","journal-title":"Health Prospect"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.3332\/ecancer.2018.ed86","article-title":"Precision oncology: as much expectations as limitations","volume":"12","author":"Vasconcellos","year":"2018","journal-title":"Ecancermedicalscience"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.3332\/ecancer.2019.920","article-title":"Precision oncology in Latin America: current situation, challenges and perspectives","volume":"13","author":"Calder\u00f3n-Aparicio","year":"2019","journal-title":"Ecancermedicalscience"}],"container-title":["Exploration of Targeted Anti-tumor Therapy"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T02:33:10Z","timestamp":1786415590000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.explorationpub.com\/Journals\/etat\/Article\/1002397"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":39,"URL":"https:\/\/doi.org\/10.37349\/etat.2026.1002397","archive":["Portico","Portico"],"relation":{},"ISSN":["2692-3114"],"issn-type":[{"value":"2692-3114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]},"assertion":[{"value":"2026-01-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-21","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-10","order":2,"name":"published","label":"Published Online","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"1002397"}}