OpenOnco · Treatment Plan

Treatment plan — Colorectal carcinoma

PLAN-AUTO-CRC-001-V1 · v1 · 2026-07-26

Patient

AUTO-CRC-001 · Algorithm: ALGO-CRC-ADJUVANT

DiagnosisColorectal carcinoma

MOH / ICD-10C18-C20

ICD-O-38140/3; C18, C19, C20

Clinical significance of mutations (ESCAT)

Tumor-board context — the engine does not use these tiers to rank tracks

Biomarker	Variant	ESCAT	Evidence	Clinical significance	Drugs	Sources
BIO-MSI-STATUS	MSI-H	IA	SRC-KEYNOTE-177-ANDRE-2020 SRC-NCCN-COLON-2025 SRC-ESMO-CRC-2024 Evidence cited from clinical guidelines; per-source evidence levels not yet structured. See Phase-2-of-CIViC-pivot for re-cite roadmap.	MSI-H (microsatellite instability-high) CRC is the primary biomarker for first-line pembrolizumab monotherapy (KEYNOTE-177; mPFS 16.5 vs 8.2 mo, HR 0.60; FDA-approved 2020 for 1L mCRC MSI-H). Pembrolizumab is also FDA-approved tumor-agnostically for MSI-H/dMMR solid tumors (KEYNOTE-158, 2017). MSS/pMMR CRC does not benefit from ICI monotherapy. MSI-H (~5% of metastatic CRC) is typically detected by PCR-based fragment analysis or NGS; result correlates closely with IHC-based dMMR testing (MLH1/MSH2/MSH6/PMS2 loss). Threshold selection (MSI-H positive/negative) enforced by algorithm layer; this BMA entry surfaces ESCAT tier context only. For Lynch syndrome germline implications see BMA entries for BIO-MLH1 / BIO-MSH2 / BIO-MSH6 / BIO-PMS2.	pembrolizumab monotherapy (MSI-H 1L mCRC per SRC-KEYNOTE-177-ANDRE-2020, SRC-NCCN-COLON-2025) pembrolizumab monotherapy (tumor-agnostic MSI-H per SRC-ESMO-CRC-2024)	SRC-KEYNOTE-177-ANDRE-2020 SRC-NCCN-COLON-2025 SRC-ESMO-CRC-2024

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-CRC-ADJUVANT-STAGE3-FOLFOX

Regimen

FOLFOX (mFOLFOX6)

Drugs + NSZU

Oxaliplatin (DRUG-OXALIPLATIN) 85 mg/m² · IV over 2h, day 1 · IV ✓ NSZU covered
Leucovorin (DRUG-LEUCOVORIN) 400 mg/m² · IV over 2h, day 1 (concurrent with oxaliplatin) · IV ✓ NSZU covered
5-Fluorouracil (DRUG-5-FLUOROURACIL) 400 mg/m² IV bolus + 2400 mg/m² CIV over 46h · Day 1 bolus, day 1-2 CIV · IV ✓ NSZU covered

Reason

Primary current-line option per algorithm ALGO-CRC-ADJUVANT: selected default was filtered; promoted first remaining current-line track

Other current-line alternatives (1 tracks)

Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.

Standard plan

Indication

IND-CRC-ADJUVANT-STAGE3-CAPOX

Regimen

CAPOX (XELOX)

Drugs + NSZU

Oxaliplatin (DRUG-OXALIPLATIN) 130 mg/m² · IV over 2h, day 1 · IV ✓ NSZU covered
Capecitabine (DRUG-CAPECITABINE) 1000 mg/m² · PO BID, days 1-14 · PO ✓ NSZU covered

Reason

Current-line alternative presented for HCP consideration

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Frailty/age profile precluding doublet-intensive or triplet chemo: ECOG ≥3, OR (age ≥80 + Charlson ≥3), OR composite (age ≥75 + albumin <3.0 + ≥2 comorbidities). Triggers de-escalation toward 5-FU/LV mono, capecitabine mono, or best supportive care.
IDEA pooled analysis: 3 mo CAPOX adjuvant non-inferior to 6 mo for low-risk (T1-3 N1) stage III — explicitly designed for elderly / fragile. FOCUS-2 trial: capecitabine ± oxaliplatin in elderly mCRC showed acceptable efficacy with reduced…
RF-CRC-FRAILTY-AGESRC-NCCN-COLON-2025SRC-ESMO-COLON-2024

CONTRA-AGGRESSIVE

Hard contraindications to escalation

What NOT to do

Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity

Standard plan (IND-CRC-ADJUVANT-STAGE3-FOLFOX)

Do NOT delay adjuvant beyond 8 weeks post-surgery if avoidable — diminishing benefit thereafter
Do NOT continue oxaliplatin past Grade 2 functional neuropathy — switch to 5-FU/LV alone
Do NOT add bevacizumab in adjuvant — NSABP C-08 negative, NOT a standard

Standard plan (IND-CRC-ADJUVANT-STAGE3-CAPOX)

Do NOT use CAPOX if CrCl <30 mL/min — capecitabine renally cleared
Do NOT add bevacizumab — adjuvant bevacizumab NSABP C-08 negative
Do NOT apply IDEA 3-month data from CAPOX to FOLFOX (FOLFOX 3 mo was inferior)
Do NOT delay adjuvant beyond 8 weeks post-surgery
Do NOT continue oxaliplatin past Grade 2 functional neuropathy — switch to capecitabine alone

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · FOLFOX (mFOLFOX6)

14-day cycles × 12 cycles (6 mo) for adjuvant stage III; until progression / unacceptable toxicity for metastatic; 4 cycles (8 wk) periop trials

Standard plan

Induction · CAPOX (XELOX)

21-day cycles × 8 cycles (6 mo) adjuvant stage III; 4 cycles (3 mo) low-risk T1-3 N1 per IDEA

MDT brief

Data quality

Usable with caveats. No critical default-track gap was found, but the MDT should review the listed caveats before final sign-off.

Biomarker coverage: 0/0 known (100%), 0 missing, 0 default-track gaps
Unevaluated RedFlags: RF-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISK, RF-BLM-CONFIRMED-CARRIER, RF-CASCADE-FAP-FDR-POSITIVE, RF-CASCADE-LYNCH-FDR-POSITIVE, RF-CHEK2-CONFIRMED-CARRIER, RF-CHEK2-FAMILY-HISTORY-SUSPICION, RF-CHRONIC-IBD-CROHNS-SPECIFIC-PREVENTION, RF-CHRONIC-SEVERE-OBESITY-BMI40-PREVENTION, RF-CHRONIC-T2DM-CANCER-RISK-PREVENTION, RF-CMMRD-CONFIRMED-CARRIER, RF-COWDEN-CONFIRMED-CARRIER, RF-COWDEN-FAMILY-HISTORY-SUSPICION, RF-CRC-BRAF-V600E-POOR-PROGNOSIS, RF-CRC-EMERGENCY-OBSTRUCTION-PERFORATION, RF-CRC-FRAILTY-AGE, RF-CRC-HER2-AMP-ACTIONABLE, RF-CRC-INFECTION-SCREENING, RF-CRC-MSI-H-ACTIONABILITY, RF-CRC-OLIGOMET-LIVER-DEFINITION, RF-CRC-RAS-MUTANT, RF-CRC-RAS-WT, RF-CRC-TRANSFORMATION-PROGRESSION, RF-CRONKHITE-CANADA-CONFIRMED, RF-FAP-CONFIRMED-CARRIER, RF-FAP-FAMILY-HISTORY-SUSPICION, RF-IBD-CRC-PREVENTION, RF-JPS-CONFIRMED-CARRIER, RF-LIFESTYLE-ALCOHOL-CANCER-PREVENTION, RF-LIFESTYLE-HIGH-RED-MEAT-CRC-PREVENTION, RF-LIFESTYLE-LOW-CALCIUM-VIT-D-CRC-PREVENTION, RF-LIFESTYLE-LOW-FIBER-CRC-PREVENTION, RF-LIFESTYLE-LOW-MEDITERRANEAN-DIET-PREVENTION, RF-LIFESTYLE-OBESITY-CANCER-PREVENTION, RF-LIFESTYLE-PROCESSED-MEAT-PREVENTION, RF-LIFESTYLE-RED-MEAT-HIGH-INTAKE-PREVENTION, RF-LIFESTYLE-SEDENTARY-PREVENTION, RF-LIFESTYLE-SUGARY-BEVERAGES-PREVENTION, RF-LYNCH-CONFIRMED-CARRIER, RF-LYNCH-FAMILY-HISTORY-SUSPICION, RF-OCC-FIREFIGHTER-PREVENTION, RF-PEUTZ-JEGHERS-CONFIRMED-CARRIER, RF-PEUTZ-JEGHERS-FAMILY-HISTORY-SUSPICION, RF-PSC-CHOLANGIOCARCINOMA-PREVENTION

Technical MDT skill metadata (0/16 activated in this plan)

All registered virtual specialists. ✓ — activated for this case; ○ — not activated (available for other clinical scenarios).

Specialist	skill_id	Version	Last reviewed	Domain
Cellular therapy specialist (CAR-T)	`cellular_therapy_specialist`	v0.1.0	2026-04-25	cellular_therapy
Clinical pharmacist	`clinical_pharmacist`	v0.1.0	2026-04-25	clinical_pharmacy
Hematologist / oncohematologist	`hematologist`	v0.1.0	2026-04-25	hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)	`hematopathologist`	v0.1.0	2026-04-25	hematopathology
Infectious disease / hepatology	`infectious_disease_hepatology`	v0.1.0	2026-04-25	infectious_diseases
Medical oncologist (solid-tumor chemotherapist)	`medical_oncologist`	v0.1.0	2026-04-25	solid_oncology
Molecular geneticist / molecular oncologist	`molecular_geneticist`	v0.1.0	2026-04-25	molecular_oncology
Palliative care	`palliative_care`	v0.1.0	2026-04-25	palliative_care
Pathologist (general)	`pathologist`	v0.1.0	2026-04-25	pathology
Primary care / family physician	`primary_care`	v0.1.0	2026-04-25	primary_care
Psycho-oncologist	`psychologist`	v0.1.0	2026-04-25	psychosocial
Radiation oncologist	`radiation_oncologist`	v0.1.0	2026-04-25	radiation_oncology
Radiologist	`radiologist`	v0.1.0	2026-04-25	diagnostic_imaging
Social worker / case manager	`social_worker_case_manager`	v0.1.0	2026-04-25	psychosocial
Surgical oncologist	`surgical_oncologist`	v0.1.0	2026-04-25	surgical_oncology
Transplant specialist (BMT)	`transplant_specialist`	v0.1.0	2026-04-25	cellular_therapy

Sources cited

SRC-ESMO-COLON-2024: ESMO CRC Clinical Practice Guideline (2024)
SRC-IDEA-GROTHEY-2018: Duration of Adjuvant Chemotherapy for Stage III Colon Cancer (2018)
SRC-MOSAIC-ANDRE-2004: Oxaliplatin, Fluorouracil, and Leucovorin as Adjuvant Treatment for Colon Cancer (2004)
SRC-NCCN-COLON-2025: NCCN Colon / Rectal Cancer (v.4.2025)

Experimental options (clinical trials)

Third plan track — open-enrollment trials from ClinicalTrials.gov. Render-time metadata; engine selection is not affected by this block (CHARTER §8.3). Last synced: 2026-07-26.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT05174286	Community Health Workers United to Reduce Colorectal Cancer and Cardiovascular Disease Among People at Higher Risk	NA	RECRUITING	Columbia University	—	Single country
NCT06930586	Prognostic Value of Neurometabolic Networks in CRC (PVNM-CRC)	N/A	RECRUITING	The First Affiliated Hospital of Zhengzhou University	—	Single country
NCT07477522	Effects of High-Fiber Diet on Gut Microbiota, Metabolism, and Immune Microenvironment in Solid Tumor Patients: A Clinical Study	PHASE1	RECRUITING	West China Hospital	—	Phase 1 only Small N (<50) Single country
NCT05879783	Optical Biopsy for Peritoneal Nodules in Colorectal Patients	NA	RECRUITING	Nanfang Hospital, Southern Medical University	—	Single country
NCT06200831	Simultaneous vs. Staged Resection of Colorectal Cancer With Synchronous Liver Metastases	NA	RECRUITING	Oslo University Hospital	—	Single country
NCT02919644	Vaccination with Autologous Dendritic Cells Loaded with Autologous Tumour Homogenate After Curative Resection for Stage IV Colorectal Cancer.	PHASE2	RECRUITING	Istituto Romagnolo per lo Studio dei Tumori Dino Amadori IRST S.r.l. IRCCS	—	Small N (<50) Single country
NCT07377487	TheraSphere Japan Pre-Market Study	NA	RECRUITING	Boston Scientific Corporation	—	Single country
NCT06731998	Optimal Perioperative Pain Control in Minimally Invasive Abdominal Cancer Surgery	NA	RECRUITING	Allegheny Singer Research Institute (also known as Allegheny Health Network Research Institute)	—	Small N (<50) Single country
NCT05797467	Adjuvant Chemotherapy Combined With Targeted Therapy or Not in the T3-4N2 Colorectal Cancer Patients	PHASE3	RECRUITING	Sixth Affiliated Hospital, Sun Yat-sen University	—	Surrogate endpoint only Single country
NCT06822634	Advances in Imaging to Assess Response in Rectal Cancer	N/A	RECRUITING	NHS Greater Glasgow and Clyde	—	Small N (<50) Single country

Verify recruitment status directly with the trial site. ctgov data can lag behind current UA-site status.

Option availability in Ukraine

Per-track UA registration · NSZU · cost · access pathway. Render-time metadata; engine selection does not depend on these fields (CHARTER §8.3).

Option	UA registration	NSZU	Cost orientation	Access pathway
Standard plan FOLFOX (mFOLFOX6) (REG-FOLFOX)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Standard plan CAPOX (XELOX) (REG-CAPOX)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT05174286 Community Health Workers United to Reduce Colorectal Cancer and Cardiovascular Disease Among People at Higher Risk No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06930586 Prognostic Value of Neurometabolic Networks in CRC (PVNM-CRC) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07477522 Effects of High-Fiber Diet on Gut Microbiota, Metabolism, and Immune Microenvironment in Solid Tumor Patients: A Clinical Study No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05879783 Optical Biopsy for Peritoneal Nodules in Colorectal Patients No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06200831 Simultaneous vs. Staged Resection of Colorectal Cancer With Synchronous Liver Metastases No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT02919644 Vaccination with Autologous Dendritic Cells Loaded with Autologous Tumour Homogenate After Curative Resection for Stage IV Colorectal Cancer. No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07377487 TheraSphere Japan Pre-Market Study No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06731998 Optimal Perioperative Pain Control in Minimally Invasive Abdominal Cancer Surgery No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05797467 Adjuvant Chemotherapy Combined With Targeted Therapy or Not in the T3-4N2 Colorectal Cancer Patients No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06822634 Advances in Imaging to Assess Response in Rectal Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor

Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-07-26.

plan_id: PLAN-AUTO-CRC-001-V1 | version: 1 | generated: 2026-07-26T09:28:48.407963+00:00

Per FDA non-device CDS positioning (CHARTER §15): Outpatient oncology treatment planning to support tumor-board discussion. Not a medical device; not for autonomous clinical decision-making.

Per FDA non-device CDS positioning (CHARTER §15): Both treatment options below are presented for review. The engine's selection of a 'recommended' default does not constitute a clinical decision. Final treatment selection requires HCP judgment incorporating information not available to the system.

This document is an informational resource supporting tumor-board discussion (per CHARTER §11). It is not a system that makes clinical decisions. Every recommendation must be verified by the treating physician.