At the beginning of the New Year, President Barack Obama threw$215 million at a powerful program called “Precision Medicine”, the core of which is to study the impact of genetic variation on human health and disease formation by analyzing a pool of more than 1 million volunteers of all ages and physical conditions, in order to better understand the mechanisms of disease formation. The core of the project is to study the impact of genetic variation on human health and disease formation by analyzing a database of more than one million volunteers of all ages and physical conditions, in order to better understand the mechanisms of disease formation, which will pave the way for the development of appropriate drugs and the realization of “precision medicine. Obama even believes that “precision medicine” gives mankind a great opportunity to achieve a new medical breakthrough and usher in a new era of life-saving discoveries. So, what is “precision medicine”? The National Cancer Institute (NCI) defines “precision medicine” as medicine that uses genetic information about an individual’s disease to guide its diagnosis or treatment. The key words are “genetic information” and “diagnosis or treatment”. The first is genetic information. This encompasses five aspects of genetic variation: (1) single base mutations, such as EGFR gene mutations; (2) additional copies of genes (i.e., gene amplification), such as HER2 gene amplification in breast cancer; (3) large deletions, where deletions of DNA may result in the loss of genes that play an important role in stopping or controlling cancer growth; (4) gene recombination, such as the familiar ALK fusion gene; and (5) epistasis caused by gene mutations. Epigenetic alterations caused by gene mutations, such as methylation and microRNA, which are often mentioned nowadays. The above aspects basically cover the molecular biology basis of cancer molecular diagnosis and precision therapy. In the past 10 years, great achievements have been made in precision cancer medicine based on driver genes. Kris et al. of the Lung Cancer Mutation Consortium [1] concluded in the Journal of the American Medical Association (JAMA) that the prognosis of advanced lung cancer differs significantly depending on the presence or absence of driver genes and the corresponding treatment: patients with advanced lung cancer who have driver mutations and receive precision targeted therapy have a median survival time of 3.5 years; those who have driver mutations but do not receive the corresponding treatment have a median survival time of 3.5 years. The median survival time was 2.4 years for those with driver mutation but without corresponding targeted therapy, and only 2.1 years for those without driver gene. As you know, the median survival time for patients with advanced lung cancer receiving standard chemotherapy in 2002 was 7.4 to 8.1 months. From a survival time of less than 1 year in 2002 to a median survival time of 42 months today, this huge improvement took a total of 10 years, while from the optimal treatment in the 1960s to the so-called third-generation chemotherapy regimen in 2002, the median survival time only increased from 4 months to 8 months, a 4-month improvement that took 40 years! 10 years and 40 years! Under the banner of precision medicine, new targeted therapies for advanced lung cancer with new driver genes have gradually emerged, such as Dabrafenib for BRAF V600E mutation, anti-HER2 therapy for HER2 mutation, Crizotinib for c-MET amplification, Cabozantinib for RET fusion, and so on. In the words of a Chinese song, “We are walking on the road to socialism”. Precision cancer medicine has subdivided certain “big diseases” such as lung cancer into many “small diseases” or even “rare diseases”, such as ROS1 positive lung cancer, which accounts for only about 1% of lung adenocarcinoma. Lung cancer is a major disease. Lung cancer is a major disease, while ROS1 lung cancer is a minor disease. At the same time, precision medicine has linked many different cancers together to form a new class of diseases, such as the well-known “ALKoma”, which is a fusion of ALK genes in lung cancer, malignant lymphoma, and some rare pediatric tumors, all of which can be treated with ALK inhibitors. These changes in clinical oncology brought about by precision medicine also bring new challenges to clinical research in precision cancer medicine. The American Association for Cancer Research (AACR) highlighted in its 2014 Advances in Cancer that innovative clinical trials for precision cancer medicine can be divided into two categories, called “Basket Trials The first is called “Basket Trial”. The essence of a “basket trial” is that one drug is used to treat different tumors. The second type of clinical trial is called “Umbrella Trial”, which is an umbrella under which lung cancers with different driver genes, such as KRAS, EGFR, and ALK, are gathered under the same umbrella, and this umbrella is to complete different target tests at the same time and then assign different precise target drugs according to different target genes. The greatest advantage of the Umbrella trial is that it brings together very rare mutations and turns them into “common” events, which is particularly important for accelerating clinical trials for rare diseases and for giving an individual a chance to get a precise treatment. The most representative example of a basket trial is ALKoma, a mutation in the ALK gene that is a driver not only for non-small cell lung cancer, but also for other malignancies including lung cancer, lymphoma, kidney cancer, neuroblastoma, and others. This means that by managing the same molecular event, it allows different tumors with this driver gene to be treated with the same drug. The ongoing clinical trial of crizotinib A8081013 (ClinicalTrials.gov Identifier: NCT01121588) is a Basket trial that includes all of these malignancies. In addition to ALK, EGFR, HER2, BRAF and other genes may play a driving role in different tumors and can be included in the basket. Among them, BRAF research is in full swing. BRAF mutations can be detected in multiple myeloma, melanoma, ovarian cancer, colon cancer, thyroid cancer, choriocarcinoma, gastrointestinal tumors, lung cancer, and many other cancer types. basket trials for BRAF V600E are also underway. The MASTER trial (ClinicalTrials. gov Identifier: NCT02154490), initiated by the NCI, is a typical Umbrella clinical trial. The study specifically targeted patients with squamous carcinoma and divided them into four groups according to different biomarkers, and gave them the appropriate drug treatment for each of the four biomarkers. These two types of trials, Basket and Umbrella, are revolutionary innovations for accelerating the development of precision therapies and clinical oncology, as they may take only a few dozen patients to receive accelerated approval and get the drugs to market once they are started. Cancer patients will be able to have access to effective therapeutic drugs much faster than the long wait of 7 to 10 years that was required in the past. The relationship between EGFR mutant genes and targeted drugs was just discovered in 2004, and Chinese scholars quickly seized the opportunity to start with the molecular epidemiology of EGFR mutant genes in the Chinese population and to lead the way in making biomarker-based patient selection clinical trials. clinical practice in advanced lung cancer [2]. The recently launched CLUSTER clinical trial (ClinicalTrials.gov Identifier: NCT02276027) is the first multi-targeted Umbrella trial in Asia. The road ahead lies beneath our feet. But can the Chinese government, like Obama, declare an era of great discoveries in precision medicine?