Genomic profiling of adolescent and young adult cancers in Asia: A scoping review.

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Background: Adolescents and young adults (AYAs, aged 15–39 years) represent a distinct yet under-recognised cancer population, with survival outcomes that lag behind those of paediatric and older adult patients across many cancer types. Despite this, treatment strategies for AYAs are frequently extrapolated from other age groups rather than informed by age-specific evidence. In Asia, genomic data on AYA cancers remain particularly limited. This scoping review maps existing genomic profiling studies; to characterise the current evidence base and highlight gaps relevant to advancing precision oncology for Asian AYA patients. Methods: We conducted a scoping review following JBI methodology and PRISMA-ScR guidelines over three databases (PubMed, Embase, Scopus). Studies involving Asian AYAs undergoing multi-gene genomic profiling were included. Two reviewers independently screened titles, abstracts, and full texts, with data extracted using standardised forms. Results: We identified 14 studies published from 2006-2025, most within the past decade. More than half of the identified studies were conducted in East Asia (e.g. China, Japan). Colorectal and breast cancers predominated, while other cancer types prevalent among AYAs were strongly underrepresented. Across tumour types, AYAs exhibited distinct genomic features compared with older adults. These included differences in driver mutations, lower tumour mutational burden and higher rates of pathogenic germline variants. While most studies identified actionable mutations, only two studies utilised genomic findings in guiding eventual therapy. Conclusions: While emerging evidence indicates that Asian AYA cancers are characterised by age- and population-specific genomic patterns, its translation into clinical practice remains limited. Substantial regional inequities in sequencing access and research capacity further constrain implementation, particularly in under-resourced settings. Improved evidence synthesis will depend on harmonised AYA definitions and wider implementation of validated frameworks to evaluate and tier actionable alterations. Beyond methodology, an important paradigm shift is needed: recognising the unique tumour biology of AYAs and incorporating this explicitly into clinical data stratification and interpretation. Generating clinically meaningful, outcome-linked genomic evidence will also require deliberate efforts to improve AYA inclusion in clinical trials, enabling genomics-guided approaches to be evaluated and implemented across diverse Asian settings.