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Advances in precision oncology have made genotyping mandatory for most advanced solid tumors to ensure proper therapy selection. However, the innovations remains limited by the realities of patient identification-actionable targets are present in only a small fraction of patients. We initiated a nationwide cancer genome screening project, SCRUM-Japan GI- (from 2015 to 19)/MONSTAR-SCREEN (since 2019) with the purpose of matching patients with interventional IND trials. We revealed requirement for tissue samples hampers recruitment, and genotyping using archival tumor samples provides information only at a single spatial and temporal point and fail to detect chronological tumor evolution and intratumoral heterogeneity, both of which are obstacles for proper therapy selection. We also demonstrated circulating tumor DNA (ctDNA) analysis using next-generation sequencing (NGS)-based methods have the potential of ctDNA analysis for genomic profiling as an alternative for tissue genotyping. Recently, gut microbiome has the promise in predictive value of therapy. Serial analyses with ctDNA and microbiome at pre- and post- cancer therapies are ongoing. Updated results will be presented.

SL-1 Activity on Nationwide Cancer Genome Screening Project for Advanced Solid Tumors; SCRUM-Japan GI-/MONSTAR-SCREEN