Tissue-agnostic cancer therapies promise to revolutionize oncology by targeting molecular drivers. Sledge et al.’s study of nearly 300,000 tumors found 21.5% with tissue-agnostic indications. Despite nine FDA approvals, real-world implementation challenges persist. Progress depends on universal genomic testing, an oncogenomic-savvy workforce, innovative trials, updated regulations, and real-world evidence to maximize potential.