The advent of personalised or precision medicine with molecularly targeted therapies for cancer is not only challenging the delivery of oncology and pathology services but wider aspects of the health care system, including the funding model.

The molecular pathology component of the Cancer 2015 has demonstrated the feasibility of adopting real-time next generation sequencing for mutational profiling of tumour samples from Victorian metro and regional centres. Significantly, it has provided data suggestive for a new classification for at least some cancers (e.g. head and neck, CUP) that will open unexpected avenues for investigation and treatment in these poor prognosis tumours. Furthermore, it has also demonstrated significant differences in mutation type and frequency compared with that previously reported and also identified actionable mutations in tumours not usually thought to harbour such genetic changes. These significant findings will be presented here.

We will also present plans for future analyses will a larger sample (Phase II).  A second deeper mutational screen will be performed on advanced stage patients to select patients for enrolment into clinical trials for novel therapies.  The mutational data provided from these layers of investigation will also be used to:

- characterise the genetic landscape of cancers in the Victorian population

- integrate real-time reporting into a multidisciplinary molecular tumour board

-  develop a molecular genetic classification of cancer

- develop a measure of tumour heterogeneity and evolutionary ability

-  identify common mechanisms of resistance to specific targeted therapies

-  develop highly sensitive tests from blood to facilitate patient management.

 The data generated will also importantly enable a whole of system health economic modelling of the costs of this personalised cancer approach. The direct research outcomes include:

- Real-time identification of actionable mutations leading to additional therapeutic options

- Enhanced participation in clinical trials

-  Clarification of the underlying molecular mechanisms and pathological significance of mutations in tumours.