A framework to rank genomic alterations as targets for cancer precision medicine: the ESMO Scale for Clinical Actionability of molecular Targets (ESCAT). (21st August 2018)

• Record Type: Journal Article
• Authors: Mateo, J; Chakravarty, D; Dienstmann, R; Jezdic, S; Gonzalez-Perez, A; Lopez-Bigas, N; Ng, C K Y; Bedard, P L; Tortora, G; Douillard, J -Y; Van Allen, E M; Schultz, N; Swanton, C; André, F; Pusztai, L
• Is Part Of: Annals of oncology. Volume 29:Number 9(2018)
• Page Start: 1895
• Page End: 1902
• Publication Date: 2018-08-21
• Subjects: precision medicine -- targeted therapies -- biomarkers -- genomics -- next-generation sequencing -- classification system; Oncology -- Periodicals; 616.992
• DOI: 10.1093/annonc/mdy263
• Languages: English
• ISSNs: 0923-7534

Abstract

Abstract: Background: In order to facilitate implementation of precision medicine in clinical management of cancer, there is a need to harmonise and standardise the reporting and interpretation of clinically relevant genomics data. Methods: The European Society for Medical Oncology (ESMO) Translational Research and Precision Medicine Working Group (TR and PM WG) launched a collaborative project to propose a classification system for molecular aberrations based on the evidence available supporting their value as clinical targets. A group of experts from several institutions was assembled to review available evidence, reach a consensus on grading criteria and present a classification system. This was then reviewed, amended and finally approved by the ESMO TR and PM WG and the ESMO leadership. Results: This first version of the ESMO Scale of Clinical Actionability for molecular Targets (ESCAT) defines six levels of clinical evidence for molecular targets according to the implications for patient management: tier I, targets ready for implementation in routine clinical decisions; tier II, investigational targets that likely define a patient population that benefits from a targeted drug but additional data are needed; tier III, clinical benefit previously demonstrated in other tumour types or for similar molecular targets; tier IV, preclinical evidence of actionability; tier V, evidence supporting co-targeting approaches; and tier X, lack of evidence for actionability. Conclusions: The ESCAT defines clinical evidence-based criteria to prioritise genomic alterations as markers to select patients for targeted therapies. This classification system aims to offer a common language for all the relevant stakeholders in cancer medicine and drug development.