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ESMO Scale for Clinical Actionability of molecular Targets (ESCAT)

A framework to rank genomic alterations as targets for cancer precision medicine

A collaborative project initiated by the ESMO Translational Research and Precision Medicine Working Group  provides a systematic framework to rank molecular targets based on evidence available supporting their value as clinical targets.

Implementation of a harmonised vocabulary would help clinicians to prioritise cancer genomic abnormalities when interpreting genomic reports and facilitate communication between academia, pharmaceutical industry, healthcare professionals and patients.

The ESCAT is published in 2018 in the Annals of Oncology and accompanied with a press release.

To enquire or ask questions about the ESMO Scale for Clinical Actionability of molecular Targets, please send an email to education@esmo.org 


The ESCAT ranking was determined to support the ESMO Precision Medicine Working Group recommendations for the use of next-generation sequencing for patients with metastatic cancers.

In 2021, the ESMO-EURACAN-GENTURIS Clinical Practice Guideline for diagnosis, treatment and follow-up of gastrointestinal stromal tumours and the ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer integrated ESCAT scores for genomic alterations with actionable drug matches.

In 2022, the ESCAT scores were included in updated thyroid cancer, new gastric cancer, oesophageal cancer, metastatic colorectal cancer, salivary gland cancer, and biliary tract cancer treatment recommendations.

In 2023, the ESCAT scores were included in treatment recommendations for oncogene-addicted metastatic non-small cell lung cancerepithelial ovarian cancerpancreatic cancer, and early breast cancer.

Besides the use in discussion and decision processes by the institutional molecular tumour boards, the ESCAT tiers classification may serve as a support tool for reimbursement. In February 2023, the Italian Ministry of Health has approved, for genomic profiling of tumours by NGS, the access and reimbursement of targeted drugs authorised by the Italian Medicines Agency (AIFA) in cases that meet criteria of genetic alterations associated with ESCAT level I of actionability.

The ESCAT was presented at various oncology events, e.g. presentation by Joaquin Mateo on ‘Ranking genomic alterations for precision medicine: New developments of ESCAT’ at ESMO 2019 Congress, or ‘What we need to bring into the equation: The ESMO ESCAT’ at ESMO 2020 Virtual Congress, or ESCAT presentation by Fabrice André at ESMO Advanced Course on Biomarkers for Precision Medicine in 2019, as well as original research presentations on clinical utility of genomic alterations based on ESCAT at various events. 

The ESCAT is also covered by a number of news, from a press release to oncology news on feasibility of treatment guidance in solid tumours based upon ESCAT in clinical practice, or ranking of molecular alterations in particular tumour types.

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