ESMO Congress 2026

In precision oncology, the need for tools that translate molecular variants into treatment decisions is backed by solid evidence. A review of integrative genomics noted that sequencing tumor biopsies can match therapies at the molecular level, track response, and detect drug resistance and the mechanisms by which it occurs, though clinical adoption is held back by logistical, regulatory, financial and ethical considerations ^[2]. In the real world, the Molecular Tumor Board (MTB) at Fondazione IRCCS Istituto Nazionale Tumori of Milan evaluated 1,996 patients with advanced/metastatic solid tumors between May 2020 and October 2021, identifying more than 10,000 variants, 43.2% of them pathogenic or likely pathogenic, showing that variant interpretation and treatment matching have become routine clinical work ^[5]. On the economics side, an analysis of oncology medicines approved by the FDA between 1997 and 2020 showed average R&D cost estimates ranging from $765 million to $4.6 billion, while a companion diagnostic (CDx)-informed precision oncology approach is considered to deliver effective therapies within health system cost constraints ^[6].

Two pieces of news emerged from the scene. The main one, from @YGaritaonaindia, is that ESCAT v2 is out in Annals of Oncology, timed ahead of #ESMO26: the post explicitly says the decision trees are very informative, covering both actionability and the new resistance scale, and that high-quality real-world evidence (RWE) is formally graded in tier II. The other, from @touchONCOLOGY, previews six themes of ESMO 2026, naming the evolving role of immunotherapy and antibody–drug conjugates (ADCs), precision oncology, early detection and patient-centred care; it is agenda anticipation without specific study data.

Against existing knowledge, the step forward maps directly onto the background facts: a single MTB had to handle more than 10,000 variants from 1,996 patients between May 2020 and October 2021 ^[5], so actionability assessment urgently needs a standardized path, and the ESCAT v2 decision trees turn that assessment into a traceable process; precision oncology itself requires detecting drug resistance and its mechanisms at the molecular level ^[2], and the new resistance scale plus high-quality RWE entering tier II brings resistance assessment and real-world evidence into the grading system, echoing the evidence orientation of the CDx-informed development approach that emphasizes delivering effective therapies within cost constraints ^[6].

Limitations should also be noted: the posts are social media messages; the specific grading criteria of the ESCAT v2 decision trees, the scoring details of the resistance scale, and the methodological threshold for RWE entering tier II are all undisclosed, pending the Annals of Oncology full text; the six-theme preview post likewise contains no specific study data.