Two patients (Cases #1 and #3) were seen in the authors’ clinic. Observations of rapid progression and genomic commonalities prompted further investigation via database and chart review. Consequently, we analyzed all patients with stage IV cancers who received immunotherapies (CTLA-4, PD-1/PD-L1 inhibitors or other [investigational] agents) (March 2011 through July 2016) and had tumor evaluated by NGS (Foundation Medicine, Cambridge MA) at Moores UCSD Cancer Center (N=155). When available, clinical information including lymphocyte count, albumin, lactate dehydrogenase (LDH), number of organ metastases and Eastern Cooperative Oncology Group Performance Status (ECOG PS) were collected (laboratory, radiographic and ECOG PS information was collected within 4 weeks of the initiation of immunotherapy). Royal Marsden Hospital score (11 (link)) and MD Anderson Cancer Center prognostic score (12 (link)) were evaluated when available. This study was performed in accordance with the guidelines of the UCSD Internal Review Board (PREDICT protocol; NCT02478931) and the investigational studies for which the patients gave consent.