ESMO updates its framework for ranking cancer biomarkers
The European Society for Medical Oncology has released a second version of its ESCAT framework for judging how useful molecular alterations are in guiding targeted cancer therapy. The update adds clearer distinctions within its top evidence tier, criteria for tumor-agnostic treatments, and a new scale for resistance biomarkers. It is intended to help oncologists interpret genomic test results and choose treatments with greater confidence.
The original ESCAT framework appeared in 2018 as a shared way to rank genomic changes by how strongly evidence supported their use in precision oncology. Version 2, published in Annals of Oncology, keeps its core principles while clarifying Tier I: it separates levels of certainty about a biomarker-treatment match without changing the recommendation to use it.
It also sets formal criteria for tumor-agnostic treatments through ETAC-S, gives more detailed guidance on prospective and real-world evidence, and adjusts lower tiers to reflect current evidence pathways. A separate resistance scale—described as the first systematic, evidence-based one developed independently of regulatory approvals—helps classify biomarkers linked to reduced or absent benefit.
Oncologists and patients may benefit if clearer biomarker rankings make genomic test reports easier to interpret and treatment choices more consistent. Labs and tumor boards also could use the framework to standardize discussions, while health systems may see more uniform evidence assessments. Because it addresses resistance markers, clinicians may better plan treatment sequencing, potentially sparing some patients ineffective therapies. Its practical influence will depend on adoption in guidelines, diagnostic reports, and routine care.