Objectives: The purpose of this study is to confirm, whether detailed genetic testing of patients with advanced tumor stage provides the basis for new molecular targeted therapies and to determine, if detailed genetic testing extends treatment options and improves the outcome. In addition, the frequency of molecular alterations and their level of evidence were determined in an unselected group of patients. Furthermore, we investigated the frequency of targetable genomic aberrations and the proportion of patients actually treated with targeted therapy. Materials and Methods: 54 patients who received detailed genetic testing in the year 2020 to detect possible pathogenic mutations were included in this study. All of them were diagnosed with cancer and treated at the oncologic ambulatory health care center in Coburg. In total, 58 detailed genetic tests were performed using the Oncomine Comprehensive v3 panels or the Oncomine Focus panels. Electronic medical records were reviewed for the patient characteristics and Evidence Level classification was used to help interpreting somatic variants and evaluate their diagnostic, prognostic and therapeutic implications. Results: Most (70%) of the patients with different cancer types exhibit a targetable genetic alteration but only 14.8% of the patients eligible for targeted therapy received a targeted therapy. The majority (70.4%) of patients, regardless of whether they received targeted therapy or not, deceased between the time the test was performed in 2020 and the time the data was collected. Also, there was no significant difference between the patients receiving targeted therapy and those receiving a physician’s choice therapy regarding their death 3 months after performing the detailed genetic test. Conclusions: Predominantly elderly patients with advanced disease and multiple prior therapies received detailed genetic testing. Even though a substantial number of unselected incurable cancer patients exhibit targetable genetic alterations and are eligible for targeted therapy only a few of the patients actually receive it. This is attributed to difficult drug development targeting genomic aberrations, high costs of clinical trials and available drugs as well as limited access of patients to clinical trials. Also a high mortality of the patients was observed regardless of whether they received targeted therapy or not.