Two patients. Same hospital. Same diagnosis: lung cancer.
Both receive the same chemotherapy. One responds well. The other doesn’t.
For decades, cancer treatment followed a simple rule. Identify where the tumor originated and treat that organ. But doctors now know that two patients with the same cancer can have very different genetic mutations, causing them to respond differently to treatment. This is where precision oncology comes in.
Precision oncology looks at the genetic profile of the tumour, not just where the cancer started. Before treatment begins, doctors identify mutations like EGFR, ALK, BRCA, and HER2. Then they select therapies that attack the biology of the tumor, not just the organ where it originated.
The goal is to improve patient outcomes and avoid ineffective therapies.
As advances in genomics make this approach more accessible, precision oncology is beginning to reshape not only cancer treatment but also where the biggest opportunities are emerging across India’s healthcare ecosystem.
Why This Shift Is Different From Past Healthcare Trends
Every few years, the healthcare system undergoes a transformation that reshapes the industry.
The discovery of antibiotics changed how infectious diseases were treated. Robotic and minimally invasive surgeries are transforming the operating rooms. And, more recently, biologic medicine revolutionised the treatment of autoimmune disorders.
Precision oncology could be the next big shift. Unlike many healthcare trends, this one is backed by powerful structural forces.
Rise in cancer cases: In India alone, nearly 15.6 lakh new cancer cases and more than 8.7 lakh cancer-related deaths occurred in 2024, according to ICMR. More importantly, based on the trends, annual cancer cases could rise to nearly 25 lakh by 2045.
Cost of sequencing is dropping: Genome sequencing, previously thought to be expensive and hard, is getting faster and cheaper. As costs go down, precision diagnostics become more economically viable for hospitals, labs, and patients.
AI is accelerating discovery: Artificial intelligence is taking less time to find disease-causing mutations and connect them with potential therapies.
Pharma is following the money: Global pharmaceutical companies are investing billions of dollars to develop targeted therapies that act on specific genetic abnormalities. Oncology is already the largest therapeutic area in global R&D spending, and that share is growing.
India is also building the infrastructure needed for this transition. IIT Madras launched the Bharat Cancer Genome Atlas in February 2025, a landmark project to map the genetic landscape of Indian cancer patients. In July 2025, India launched its National Biobank at the CSIR-Institute of Genomics and Integrative Biology in New Delhi, creating a longitudinal national health database to support personalised treatment research.
Market Opportunity in Precision Oncology
The global precision oncology market was valued at about $115 billion in 2024 and is expected to reach $200 billion by 2029, implying a CAGR of 11-12% through the period. Within this, the fastest-growing segment is precision diagnostics. This helps to identify the genetic mutations that determine which targeted therapies are likely to work.
India’s precision oncology market is also growing fast. Grand View Research reports that the market was valued at $4.4 billion in 2024 and is projected to grow to $8.9 billion by 2030, exhibiting a CAGR of 12.6%.
The oncology companion diagnostic market is growing even faster. This test helps doctors to identify which patients are likely to benefit from a specific targeted therapy. The Indian market was valued at $111.4 million in 2024 and is projected to reach $255.4 million by 2030, growing at a CAGR of 13.9%.
Companies Positioned to Benefit From the Shift
Precision oncology is creating opportunities across the entire healthcare value chain. From hospitals, diagnostics chains, pharma and medical devices manufacturers, to contract research organisations.
However, not every healthcare company is equally positioned to benefit from this structural shift.
Hospitals gain the most from increased patient volumes, regardless of how cancer is treated. Most of the pharma companies in India are in the generics space, and only a few are directly involved in the discovery of next-generation precision therapies.
Among the listed Indian companies, Metropolis Healthcare and Syngene International sit closer to the precision oncology value chain and have made it a core part of their long-term strategy.
Stock #1: Metropolis Healthcare: Building India’s Precision Oncology Platform
Precision oncology begins with a test. Before a targeted therapy can be prescribed, a patient’s tumour must be sequenced and the right mutation identified. This is where Metropolis Healthcare is placing its bet.
India has several diagnostic chains, including Dr Lal Pathlabs and Vijaya Diagnostic, which have added molecular diagnostics and genome testing, but none are building an oncology-focused business like Metropolis Healthcare.
Not Just Another Acquisition, A Strategic Bet
Metropolis in December 2024 announced the acquisition of Gurugram-based Core Diagnostics for ₹246.8 crore. It was not just another acquisition. It was a strategic bet that made Metropolis an overnight top-tier oncology-focused diagnostic chain.
Core Diagnostics built its business around high-complexity cancer diagnostics. The company offers more than 1,300 high-end tests, with a primary focus on cancer, serving more than 6,000 specialty prescribers, including 1,600+ top cancer specialists. Core reported revenue of ₹110 crore in FY24, with a three-year revenue CAGR of ~22%.
How Core Acquisition Helps Metropolis
The acquisition materially changes Metropolis’s business mix. Before the deal, oncology testing accounted for approximately 4% of Metropolis’s revenue. Post-acquisition, that figure rises to approximately 10%.
Now, Metropolis, through its 5,000-plus collection centres across more than 750 towns, can offer advanced oncology and genomics tests. Samples that are collected locally, and diagnosis is performed at Core’s specialist laboratories. The acquisition, therefore, creates a powerful combination of Core’s scientific expertise and Metropolis’ nationwide reach.
Financial Turnaround at Core
At the time of the acquisition, Core had an EBITDA margin of around-2%. The management committed to turning that around to a high single-digit within four quarters, a target that was achieved by Q4 FY26, on schedule. The longer-term objective is to push EBITDA margins to more than 20%, which would make Core one of the highest-margin businesses within the Metropolis portfolio.
This financial turnaround matters for the headline numbers, too. Metropolis’s group revenue for FY26 came in at ₹1,646 crore, growing 24% year-on-year. Net profit rose 31% to ₹191 crore.
EBITDA margin for the full year reached 24.4% in FY26, driven by operating leverage, better test mix, and early synergies from Core. Management has set a three-year target of 14-15% revenue CAGR and group EBITDA margins of 27-28%.
How the Market is Valuing Metropolis
Metropolis Healthcare: P/E Trend
| Company | P/E | 5Y Median PE | Ind PE |
| Metropolis Healthcare | 57.4 | 58.7 | 47.6 |
On a market cap of around ₹11,200 crores, the stock trades at a trailing P/E of roughly 58. By no means can we say it is a cheap stock. Alongside, Metropolis commands a premium valuation compared to most listed diagnostic players in the market, suggesting that the market is already pricing in a large part of its long-term growth opportunity.
Metropolis has relatively little room for execution missteps. To justify its premium valuation, Metropolis will need to consistently deliver on its broader growth strategy and meet the market’s high expectations.
Stock #2: Syngene International- Enabling the Next Generation of Cancer Therapies
If Metropolis represents the diagnostics side of precision oncology, Syngene represents the research side.
Precision oncology is changing how cancer drugs are developed. As researchers discover more genetic mutations that drive cancer, pharmaceutical companies are developing therapies that target these specific mutations.
This creates a chain reaction. More genetic mutations identified means more targeted therapies need to be developed. That, in turn, increases the demand for biologics and antibody-drug conjugates (ADCs). These therapies require extensive drug discovery, testing, and manufacturing, prompting global pharmaceutical companies to outsource more of this work to specialised contract research, development, and manufacturing organisations (CRDMOs).
This is where Syngene has built a strong competitive position.
As India’s leading CRDMO, it works with 16 of the world’s top 20 pharmaceutical companies and more than 400 global customers across drug discovery, development, and manufacturing. Oncology is one of its largest therapeutic areas.
Why Syngene Stands Out
Syngene stands out for its scientific capabilities and the quality of its client base. It’s in partnership with Bristol Myers Squibb (BMS), one of the world’s biggest oncology companies. The partnership has been extended through 2035. Around 700 Syngene scientists work from a dedicated research centre in Bengaluru, supporting BMS across several therapeutic areas, including oncology.
The company is also expanding into antibody-drug conjugates (ADCs), one of the fastest-growing classes of targeted cancer therapies. In Q4FY26, Syngene commissioned a new ADC discovery laboratory. This positions it among a select group of global CRDMOs with full-service ADC capabilities.
Syngene is also expanding in biologics, biomarkers, and other advanced modalities, areas where oncology accounts for a large share of global R&D spending. As pharmaceutical companies invest more in precision oncology, Syngene is positioned to benefit through higher demand for these specialised research and manufacturing services.
FY26: A Temporary Setback
Syngene’s stock price has corrected by almost 30% in the last 6 months, and it’s not due to any deterioration in fundamentals. Instead, the weakness stems from a large-scale inventory correction by one of its largest biologics customers. As a result, the EBITDA margin compressed from 29% in FY25 to 25% in FY26.
Because of the event, management is cautious in any upward revision in margin, and has guided EBITDA margins in the mid-20s for FY27. The primary reason why the stock price has corrected by around 30%.
How the Market is Valuing Syngene
Syngene International: P/E Trend
| Name | P/E | 5Y Median PE | Ind PE |
| Syngene International | 46.9 | 56.6 | 40.4 |
Syngene currently trades at a trailing P/E of 46.9, below its own five-year median of 56.6, reflecting the market’s caution around the FY26 margin compression. In other words, the 30% stock correction has already pulled the valuation off its historical peak.
At the same time, Syngene still commands a premium over its industry peers, which trade at roughly 40x earnings. The market hasn’t abandoned the long-term thesis. It is just demanding proof that the FY26 slowdown was a temporary blip before it reprices the stock. If the recovery takes longer than expected, there’s still some downside to the current multiple.
The Opportunity Comes With Risks
While the long-term opportunity is compelling, both companies face execution risks.
For Metropolis, the key challenge is successfully scaling Core Diagnostics and achieving the targeted improvement in margins. The stock also trades at a premium valuation, leaving little room for execution missteps.
For Syngene, the focus is on converting its investments in ADCs, biologics, and other advanced modalities into commercial contracts. The company also needs to deliver the expected recovery in growth after the temporary slowdown.
More broadly, the company remains exposed to global pharmaceutical R&D spending, particularly in the US. Any slowdown in biotech funding or drug development could impact demand for its services.
Despite these risks, precision oncology is more than just another healthcare trend. It represents a fundamental shift in how cancer is diagnosed and treated. While the transition is still in its early stages globally, it has the potential to reshape the healthcare value chain over the coming decade.
Metropolis Healthcare and Syngene International are among the few listed companies already positioning themselves for that future. Long-term investors looking to participate in one of the most significant structural shifts in healthcare both deserve a place on your stock watchlist.
Note: We have relied on data from www.Screener.in throughout this article. Only in cases where the data was not available, have we used an alternate, but widely used and accepted source of information.
The purpose of this article is only to share interesting charts, data points and thought-provoking opinions. It is NOT a recommendation. If you wish to consider an investment, you are strongly advised to consult your advisor. This article is strictly for educative purposes only.
Deepan Datta has spent over a decade studying stocks and mutual funds. His passion is to uncover interesting stories in the financial markets and share them through his writings with investors at large. He is focused on delivering clear, easy to understand and research-backed insights. Deepan began his career as a Research Associate at S&P Global, where he developed a strong foundation in financial research and data analysis.
Disclosure: The writer and his dependents do not hold the stocks discussed in this article.
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