Sequencing DNA in archival specimens like Foundation has significant limitations. The ability to predict drug responses from this data alone seems quite limited

Sequencing DNA in archival specimens like Foundation has significant limitations. The ability to predict drug responses from this data alone seems quite limited. For example, the most common alteration, loss of function variants in TP53, is not at present druggable. Additionally, one of the greatest revolutions in cancer therapy - immunotherapy - does not have a great genomic-based predictive biomarker (Foundation Medicine has created a surrogate test using mutation burden, but this is not really good enough, and not validated prospectively). So DNA sequencing is only part of the story. Some tumours in particular seem driven by epigenetic changes, or structural variants that Foundation cannot detect. Sequencing is in a place where it has reached technical maturity, and has collided with big data hype. But in reality, the benefit to patients will be incremental. There is at present zero good quality evidence that panel based genomic screening like Foundation Medicine provides improves patient outcomes as a general strategy.