Diagnostics are now fully embedded in the oncology patient journey, helping clinicians identify the right patients, select appropriate treatments, and monitor disease over time. For Espen Walker, Head of Global Medical Diagnostics at AstraZeneca, diagnostic strategy plays a critical role in supporting precision oncology by connecting biomarker testing, real-world evidence, and treatment decision-making across tumour areas.
In his role, Walker works with medical affairs diagnostics teams to help drive precision oncology across healthcare. This includes identifying where biomarkers are needed, and where their use may be limited or not appropriate, and how diagnostic testing can support broader tumour area strategies. He also emphasises the importance of collaboration across patient groups, academia, industry, and healthcare organisations to ensure diagnostics are developed and adopted in ways that aim to create real value for patients.
As biomarkers become increasingly central to treatment selection, a diagnostic test is most useful when it is integrated into real-world clinical practice. Testing is no longer a one-off step at diagnosis. Instead, it is becoming a continuous part of the patient journey, helping clinicians understand how tumours evolve and how treatment decisions may need to change over time.
Liquid biopsy, particularly ctDNA testing, is an important part of this shift. By enabling non-invasive assessment at different points in the disease journey, ctDNA has the potential to help clinicians understand tumour biology, monitor molecular changes, and inform whether additional testing or treatment adjustments may be considered, where clinically appropriate and validated. When combined with imaging, tissue testing, clinical characteristics, and patient-reported information, diagnostics may help contribute to a more holistic view of the patient.
Digital biomarkers and computational pathology are also becoming increasingly important. Walker highlights their potential to be explored for supporting patient identification, response assessment, and access to care. However, wider adoption requires more than strong science. Healthcare systems need the right infrastructure, local evidence, and practical workflows to integrate these tools into routine care in line with regulatory and clinical validation requirements.
One promising model is a hub-and-spoke approach, where local centres can collect samples or digitised slides and send them to centralised expert centres for analysis. This may help patients remain closer to their local healthcare providers while still benefiting from advanced diagnostics, liquid biopsy, and computational pathology expertise, where available.
Looking ahead, oncology diagnostics are expected to become more complex, multimodal, and AI-enabled. Digital biomarkers, liquid biopsy, imaging, tissue analysis, genomics, and clinical data may increasingly be combined to guide diagnosis, monitor patients, and support clinical trial matching. Walker also points to the future role of digital twins and advanced analytics in exploring ways of predicting treatment response and improving real-world evidence generation, although these approaches remain under research and development.
However, as AI and multimodal diagnostics advance, the quality of data will be critical. Clean, reliable, well-structured data will be essential to ensure that these tools solve real clinical problems rather than simply adding complexity. Human expertise will remain important in validating data, interpreting results, and ensuring that technology is used responsibly.
The future of precision oncology will depend on strong partnerships between healthcare professionals, patients, technology companies, pharmaceutical companies, diagnostic developers, and academic groups. By integrating diagnostics more effectively across the patient journey, oncology care can move closer to a future where each patient may receive more personalised, timely, and effective treatment.
