Inclusion Criteria:  Age > 18 Patients with metastatic malignancy Patients undergoing tissue based molecular characterization by tissue based NGS panel  Part A - Simultaneous  Tissue based NGS panel requested Patients receiving treatment at BC Cancer Vancouver Centre  Part B - Sequential  Tissue based NGS oncopanel does NOT identify a somatic tier 1 variant of strong clinical significance OR fails/not feasible due to insufficient tissue BC Cancer - Provincial (not including Vancouver Centre)  Exclusion Criteria:  Patients not available for follow up Patients who are not willing to consider systemic treatment options