LAUSR

Detailed portraits of thousands of cancer genomes are now available, and they illustrate the variety of genomic changes that drive cancer; they are termed landscapes. Cancer landscapes include alterations such as point mutations, indels, rearrangements, amplifications, and deletions (see Table 1). Moreover, the landscapes reveal that genetic alterations common to one cancer are found at low frequencies in other cancer types. Two factors have heightened the clinical relevance of this discovery. First, it is now possible to identify patients who have these rare alterations via clinical DNA sequencing. Second, targeted therapies approved for one cancer type are often effective in other types with the same genetic driver. Thus, the clinical testing of a tumor occasionally provides a remarkable benefit to a patient. Yet, interpreting tests and selecting appropriate therapy remain a challenge. Molecular tumor boards can help to interpret genomic results, provide uniform guidelines, and track patient outcomes, but they remain inaccessible to most oncologists. Here, we provide insights into the challenges and opportunities related to using genomic tests to make clinical decisions.