The Reality Of Precision Medicine In Korea

How a multi-institutional collaboration in Korea is translating genomics, data and multidisciplinary decision-making into routine cancer care.

Precision medicine has long been positioned as the future of cancer care. Advances in genomics, data analytics and targeted therapies have transformed what is scientifically possible. Yet in many health systems, the challenge has not been innovation itself, but implementation. How do precision approaches move beyond leading academic centres and clinical trials, and become part of routine care for patients across a country?

In South Korea, a multi-institutional collaboration known as KOSMOS-II (KOrean Precision Medicine Networking Group Study of MOlecular profiling guided therapy based on genomic alterations in advanced Solid tumors)  is beginning to offer an answer. By bringing together government agencies, academic societies, hospitals and industry partners, the initiative is demonstrating how precision medicine can be operationalised at scale, grounded in real-world clinical practice and supported by robust data infrastructure.

Building a national precision medicine ecosystem

Launched in September 2022, KOSMOS-II was designed with a clear ambition: to establish a genomics-driven precision treatment model for patients with advanced solid tumours, while simultaneously building a national clinical genomic database to support learning, policy and future innovation.

The programme brings together the Korea Health Industry Development Institute (KHIDI), the Korean Cancer Study Group (KCSG), the Korean Society of Medical Oncology (KSMO) and the National Cancer Center (NCC). The NCC, as Korea’s government-designated National Cancer Data Center, provides the core data infrastructure, while KHIDI plays a coordinating role across public and private stakeholders. Roche, spanning both pharmaceuticals and diagnostics, participates alongside other healthcare and technology partners.

From the outset, KOSMOS-II was structured to ensure that precision medicine could be implemented in real-world clinical settings. Rather than remaining confined to a small number of tertiary hospitals, the programme was designed to extend access to regional medical centres, helping to decentralise personalised cancer care.

Expanding access to personalised treatment

To date, KOSMOS-II has supported treatment decision-making for more than 800 patients with advanced or terminal solid tumours. For many, this meant access to genomic testing and expert review processes that would previously have been unavailable outside major academic centres.

A central feature of the programme is the use of Molecular Tumor Boards (MTBs), multidisciplinary forums that bring together oncologists, pathologists and bioinformatics experts to interpret next-generation sequencing (NGS) results and identify potential treatment options. By standardising and institutionalising MTB processes, KOSMOS-II has helped embed precision decision-making into routine clinical workflows.

The programme has also produced two nationally significant guidelines: the MTB Operational Recommendation and the Clinical Practice Guideline for NGS Application in Solid Tumours. These initiatives were led by KSMO, which played a central role in shaping the academic and clinical framework for MTB operations and in translating molecular oncology expertise into nationally applicable standards of care. Together, these documents set new standards for how genomic data should be reviewed and applied in Korean cancer care, providing consistency across institutions and supporting broader adoption.

Real-world evidence influencing real-world decisions

One of the most significant outcomes of KOSMOS-II has been its contribution to policy dialogue grounded in real-world data. By systematically capturing genomic and clinical information, the programme has created an evidence base that supports discussions around treatment access, regulatory flexibility and reimbursement.

A notable example involves a patient with an ALK-positive inflammatory myofibroblastic tumour (IMT), a rare cancer with limited standard treatment options. Based on real-world clinical evidence generated through the programme, the patient received alectinib monotherapy as a first-line or palliative treatment. In September 2025, Korea’s Health Insurance Review and Assessment Service approved off-label use of the therapy, marking a milestone in the translation of precision medicine from clinical trials into everyday practice.

This case illustrates how structured data generation and expert consensus can help bridge the gap between innovation and access, particularly for patients with rare or hard-to-treat cancers.

Measuring impact through the eyes of researchers

To assess the programme’s broader impact, the KOSMOS-II partners conducted a researcher perception survey involving experts in oncology, pathology and bioinformatics. The results offer insight into how those working within the system view its value.

All respondents agreed that KOSMOS-II had contributed to innovation in Korean precision medicine and expanded treatment opportunities for patients. More than 90 percent reported that the programme strengthened the national medical ecosystem by advancing infrastructure, policy dialogue and clinical guidelines. A similar proportion recognised its role in opening up new treatment options for patients who previously had limited choices.

The survey also highlighted the perceived value of MTBs in daily practice. Ninety-five percent of medical professionals said that MTB discussions improved the effective use of NGS reports, while nearly all respondents agreed that MTBs supported the identification of optimal treatment pathways.

Importantly, researchers also emphasised the role of partnership. Industry participants, including Roche and Roche Diagnostics, were widely viewed as credible and collaborative partners, contributing technical expertise, digital solutions and long-term commitment to the programme’s goals.

Digital platforms as enablers of scale

Over the past three years, KOSMOS-II has operated across more than 30 institutions using Roche Diagnostics’ digital solution. The platform has enabled consistent case review, data sharing and documentation across sites, supporting both clinical decision-making and research.

As the programme enters its next phase, the consortium has renewed its collaboration for a further three years from October 2025. Beyond this extension, KOSMOS-II is being developed as a multi-phase initiative, with future stages aimed at expanding disease coverage, deepening the secondary use of clinical-genomic data and strengthening its role as a sustainable national precision medicine platform. 

The next phase will also introduce the Clinical Hub, an updated digital platform designed to enhance usability and data interoperability. New features include improved user interfaces, patient journey mapping, expanded document integration and advanced data extraction capabilities. Together, these tools aim to strengthen connectivity across the precision medicine ecosystem.

A model for data-driven healthcare transformation

KOSMOS-II represents more than a research project. It offers a model for how public-private collaboration can drive tangible change within a national healthcare system. By aligning clinical practice, data infrastructure and policy engagement, the programme has helped normalise precision medicine as part of routine cancer care in Korea.

At a time when health systems across Asia Pacific are grappling with how to integrate genomics, digital tools and real-world evidence, the experience of KOSMOS-II provides valuable lessons. Precision medicine succeeds not through isolated innovation, but through sustained collaboration, clear standards and a commitment to learning from real-world practice.