Non-small cell lung cancer accounts for more cancer related deaths than any other cancer type in Australia or worldwide. In adenocarcinoma, the most common histologic subtype of NSCLC, genomic alterations including mutations, fusions and gene copy number gain or loss responsible for abnormal cell growth, proliferation and metastasis can be identified in the majority of tumours. An increasing number of targeted treatments directed at these genomic drivers that improve clinical outcomes are available. However, many potentially actionable genomic alterations are not adequately identified by standard of care testing, which commonly use single gene assays or “hot-spot” panels. The ASPiRATION trial is an Australia-wide multi-centre prospective observational cohort study involving 17 participating hospitals, that will recruit 1,000 newly diagnosed patients with metastatic nonsquamous NSCLC to investigate the feasibility and clinical impact of comprehensive genomic testing using in parallel with standard of care testing. Patients with targetable alterations may be eligible for associated substudies, clinical trials or other access programs. To date over 500 patients have consent for the study. Updated results will be presented at the meeting.