Introducing whole-genome sequencing into routine cancer care: the Genomics England 100 000 Genomes Project

Large-scale sequencing studies such as the International Cancer Genome Consortium (ICGC) and The Cancer Genome Atlas (TCGA) have begun to catalogue the spectra of somatic mutations present in different solid tumour types [1, 2]. However, to date there has been minimal traction for solid tumours in alignment of large-scale sequencing data to longitudinal data on therapy and outcome. Such data are essential if we are to better target conventional cytotoxics, as well as emerging drugs such as immunotherapeutics. Stratification using molecular markers could improve benefit against cost and side-effects, especially critical in the adjuvant setting. Molecular heterogeneity of tumours and confounding patient factors mean datasets of daunting size and depth will be required. Arguably these will only be achieved through molecular analyses as standard for cancer patients entering clinical trials and, by adopting a population level approach to molecular analysis of patients undergoing routine cancer treatments.