The European Society for Medical Oncology (ESMO) has developed a tier classification for molecular targets in cancer. This can help to determine if a targeted therapy is ready for prime time or not,
Tier
Target-Drug Match
Implication
I
proven benefit in clinical trials; ready for use in routine clinical practice
standard of care
II
investigational; antitumor activity expected but magnitude of benefit unknown; more data needed
consider for prospective registry or prospective clinical trial
III
suspected to improve outcome based on data in other tumor type but not proven
clinical trials needed
IV
pre-clinical evidence
should only be used in the context of early clinical trials; patients should be told about the lack of evidence
V
objective response but without clinically meaningful improvement in outcome
might be a candidate for a clinical trial
X
no evidence of actionability
no role
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