Introduction Cancer treatment is evolving towards precision medicine. When traditional chemotherapy is not effective anymore in heavily pretreated patients, tumour profiling can be an helpful tool able to match genomic data to available target therapies.

Methods Patients treated at our Gynaecologic Oncology Unit from 09/2018 to 06/2020 with no other available standard options were proposed for the FOUNDATIONONE®CDx genomic profiling. Clinical data were collected. In case of targetable alterations, patients were treated with the suggested molecular-driven treatments, when possible. Follow-up is still ongoing.

Results We collected specimens and clinical data of 67 patients. The majority were ovarian tumors (44/67; 65.7%); 18/67 patients (26.8%) had no mutation detected, one (1.5%) had not enough cancer cells in the specimen and 10/67 (14.9%) tests are ongoing. Of the 38 patients with a viable targeted therapy, 16 (28.9%) were treated with a FOUNDATIONONE®CDx-guided targeted therapy, 5 of those with PARP-inhibitors within approved indications; one (2.6%) is waiting to start. The remaining (21/38; 55.3%) died before starting or decided for no therapy for poor performance status (tables 1–2).

Conclusions In the era of precision medicine, integration of molecular biology and targeted therapy is an effective option especially for patients with heavily treated cancers. Large randomized trials are needed to draw relevant conclusions about the patient clinical outcomes improvement and correct timing of the molecular test-guided therapies. Nevertheless, with the increasing use of target-based therapy, accessibility should be granted for all patients.