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ESMO has published version 2 of the ESMO Scale for Clinical Actionability of molecular Targets (ESCAT), a major update to the internationally recognized precision oncology framework that helps oncologists assess the clinical relevance of molecular alterations and match patients with the most appropriate targeted therapies.

First introduced in 2018, ESCAT provided a common language for ranking genomic alterations according to the strength of evidence supporting their use in precision oncology. Since then, the field has evolved, with broad adoption of tumor sequencing, the emergence of tumor-agnostic therapies, growing use of real-world evidence and increasing recognition of biomarkers that predict resistance to treatment.

These advances created the need for an updated framework that reflects contemporary clinical practice and supports confident decision-making.

Published in Annals of Oncology, ESCAT v2 retains the core principles that made the original scale widely adopted while introducing several refinements designed to increase clarity, consistency and ultimately patient benefit.

Among the most significant updates is the restructuring of Tier I, which now explicitly distinguishes between different levels of certainty supporting a biomarker-treatment match while maintaining the same clinical recommendation for use.

The new framework also incorporates formal criteria for evaluating tumor-agnostic therapies through alignment with ESMO's Tumor-Agnostic Classifier and Screener (ETAC-S) , provides more granular guidance on the use of prospective and real-world evidence and refines the lower tiers to better reflect current evidence generation pathways.

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