New ESMO Tumor DNA Scale Helps Match Patients to Optimal Targeted Treatments


Key Points

  • Click here to view the tier grading system of ESCAT.

A new scale for tumor DNA mutations called ESCAT (European Society for Medical Oncology [ESMO] Scale for Clinical Actionability of Molecular Targets) is aiming to simplify and standardize choices for targeted cancer treatment. Information about the development and use of the scale in practice was published by Mateo et al in Annals of Oncology. The goal of the use of ESCAT is to optimize patient care by making it easier to identify patients with cancer who are likely to respond to precision medicines and help make their treatment more cost-effective.

“Doctors receive a growing amount of information about the genetic makeup of each patient’s cancer, but this can be difficult to interpret for making optimal treatment choices,” explained Fabrice André, MD, PhD, Chair of the ESMO Translational Research and Precision Medicine Working Group, who initiated this project. “The new scale will help us distinguish between alterations in tumor DNA that are important for decisions about targeted medicines or access to clinical trials and those that aren’t relevant.”

How ESCAT Works

The new grading system classes alterations in tumor DNA according to their relevance as markers for selecting patients for targeted treatment based on the strength of clinical evidence supporting them. It is the first time that a classification has been developed that is relevant to all potential targeted cancer medicines, not just those that have been approved for use by national regulatory bodies. The classification also enables mutations to be upgraded or downgraded in response to newly available data.

“For the first time, ESMO has created the tools to make it clear what data are needed for a mutation to be considered actionable and how this may change in response to new clinical data,” said lead study author Joaquin Mateo, MD, PhD, Principal Investigator of the Prostate Cancer Translational Research Group from the Vall d’Hebron Institute of Oncology, Barcelona.

“The scale focuses on the clinical evidence for matching tumor mutations with the drugs we have in our clinics and gives us a common vocabulary for communication between clinicians and explaining potential treatment benefits to patients,” he continued.

As ESMO disseminates ESCAT into clinical practice, it is hoped that cancer centers and laboratories will start to routinely include Tier I-V grading of genomic mutations in patients’ clinical and laboratory reports and discuss results at tumor boards and clinics. 

“If one mutation is Tier I and another is Tier III, it is important that everyone understands the need to prioritize the Tier I mutation in determining the patient’s treatment and implementing precision medicine,” Dr. Mateo pointed out.

ESCAT will also make it easier for clinicians and patients to discuss the results of multigene sequencing. More and more patients are offered multigene sequencing, and current testing techniques frequently show that many of the genes in a patient’s tumor are mutated—but it is unclear which are relevant to treatment decisions. By using the scale to show which alterations are relevant, it will hopefully become easier to identify and agree on the right treatment for the right patient.

“ESCAT will bring order to the current jungle of mutation analysis so that we all speak the same language for classifying mutations and prioritizing how we use them to enhance patient care,” concluded Dr. André.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.