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-PDL1-CPS	(gene-level)	IA	SRC-NCCN-ESOPHAGEAL-2025 SRC-ESMO-ESOPHAGEAL-2024 Evidence cited from clinical guidelines; per-source evidence levels not yet structured. See Phase-2-of-CIViC-pivot for re-cite roadmap.	PD-L1 CPS used as eligibility threshold for ICI in metastatic esophageal cancer. Esophageal SCC: CPS ≥10 — pembrolizumab + cisplatin + fluoropyrimidine 1L (KEYNOTE-590), and pembrolizumab monotherapy 2L (KEYNOTE-181 CPS≥10 subgroup). Esophageal adeno and GEJ: same CPS criteria as gastric adeno (NCCN 2025 treats GEJ adeno with gastric algorithm). Testing by IHC 22C3 pharmDx mandatory. Threshold-gated indication selection is performed by the algorithm layer (IND-ESOPH-METASTATIC-2L-PEMBRO-CPS10); this BMA entry surfaces ESCAT tier context only.	pembrolizumab + cisplatin + fluoropyrimidine (CPS≥10 SCC 1L per SRC-NCCN-ESOPHAGEAL-2025) pembrolizumab monotherapy (CPS≥10 SCC/adeno 2L per SRC-NCCN-ESOPHAGEAL-2025)	SRC-NCCN-ESOPHAGEAL-2025 SRC-ESMO-ESOPHAGEAL-2024

Primary current-line option

Standard plan

★ DEFAULT

Indication: IND-ESOPH-DEFINITIVE-CRT-SCC
Regimen: —
Reason: Primary current-line option selected by ALGO-ESOPH-DEFINITIVE-1L at step 1.

Pre-treatment investigations

Investigations before treatment start · critical / standard / desired · merged across tracks

ID	Name	Priority	Category	Where to order	Needed for
TEST-CT-CHEST-ABDOMEN-PELVIS	CT chest + abdomen + pelvis with IV contrast	Critical	imaging	—	all tracks
TEST-CT-PET	PET-CT with FDG	Desired	imaging	—	all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Severe dysphagia with weight loss / aspiration risk in esophageal cancer: inability to swallow saliva, recurrent aspiration pneumonia, >10% weight loss in 3 months, OR malignant tracheoesophageal fistula. Mandates urgent palliative intervention (stenting OR dilation OR diversion) BEFORE any definitive systemic / RT therapy.
Self-expandable esophageal stent OR endoscopic dilation OR PEG/J-tube for nutritional support. Tracheoesophageal fistula precludes RT (worsens fistula) — covered stent + chemo only. Severe weight loss pre-CROSS predicts poor tolerance —…
RF-ESOPH-SEVERE-DYSPHAGIA-ASPIRATIONSRC-NCCN-ESOPHAGEAL-2025SRC-ESMO-ESOPHAGEAL-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-ESOPH-DEFINITIVE-CRT-SCC)

Do NOT escalate RT dose beyond 50.4 Gy — INT-0123 / RTOG 94-05 showed no OS benefit and increased toxicity at 64.8 Gy
Do NOT proceed with definitive CRT without addressing severe dysphagia / aspiration risk first (NG/PEG planning if needed)
Do NOT omit nutritional + esophagitis supportive care — CRT esophagitis peaks weeks 3-5 and limits hydration / oral intake
Do NOT switch to surgery-then-adjuvant pattern in a T4b unresectable patient — definitive CRT is the standard, not a bridge

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-ACHALASIA-ESOPHAGEAL-PREVENTION, RF-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISK, RF-BARRETTS-ESOPHAGUS-PREVENTION, RF-ESOPH-FRAILTY-AGE, RF-ESOPH-HIGH-RISK-BIOLOGY, RF-ESOPH-INFECTION-SCREENING, RF-ESOPH-SEVERE-DYSPHAGIA-ASPIRATION, RF-ESOPH-TRANSFORMATION-PROGRESSION, RF-ESOPHAGEAL-POST-CROSS-NON-PCR, RF-LIFESTYLE-ALCOHOL-CANCER-PREVENTION, RF-LIFESTYLE-HOT-BEVERAGES-PREVENTION, RF-LIFESTYLE-HOT-MATE-ESOPHAGEAL-PREVENTION, RF-LIFESTYLE-OBESITY-CANCER-PREVENTION, RF-LIFESTYLE-SMOKELESS-TOBACCO-PREVENTION, RF-OLIGOMET-DEFINITION

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-ESOPHAGEAL-2024: ESMO Esophageal Cancer (2024)
SRC-NCCN-ESOPHAGEAL-2025: NCCN Esophageal and EGJ Cancers (v.3.2025)
SRC-RTOG-8501-HERSKOVIC-1992: Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus (1992)

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
NCT07487896	A Study of YL201 Versus Investigator's Choice of Chemotherapy in Participants With Locally Advanced or Metastatic Esophageal Squamous Cell Carcinoma After Failure of First-Line Therapy	PHASE3	RECRUITING	MediLink Therapeutics (Suzhou) Co., Ltd.	—	Single country
NCT06199895	Clinical Efficacy and Safety of Paclitaxel Polymeric Micelles for Injection in the Treatment of Patients With Taxans-resistant Pancreatic Adenocarcinoma, Cholangiocarcinoma, Lung Cancer, Gastric Cancer, Esophageal Carcinoma, or Breast Cancer	PHASE2	RECRUITING	Liu Huang	—	Small N (<50) Surrogate endpoint only Single country
NCT02972372	Chemoradiation Versus Esophagectomy for Locally Advanced Esophageal Cancer	NA	RECRUITING	The First Affiliated Hospital of Henan University of Science and Technology	—	Surrogate endpoint only Single country
NCT06346080	Molecular Analysis for Gastro-Esophageal Cancer: Multicenter Discrete Choice Experiment	NA	RECRUITING	KU Leuven	—	Single country
NCT06435286	Effectiveness and Performance of an Optical Biopsy Technology for Esophageal Cancer in Brazil and the United States	PHASE2	RECRUITING	Baylor College of Medicine	—	—
NCT05173246	JS001 Combined With TP as First-line Treatment for Unresectable or Advanced Small Cell Esophageal Carcinoma	PHASE2	RECRUITING	Sun Yat-sen University	—	Small N (<50) Surrogate endpoint only Single country
NCT06569459	Trilaciclib Combined With Concurrent Chemoradiotherapy and Immunotherapy in the Treatment of Esophageal Cancer	PHASE2	RECRUITING	The First Affiliated Hospital with Nanjing Medical University	—	Single country
NCT06846346	Testing Ivonescimab in Combination With Chemotherapy in Advanced or Metastatic Gastric/Gastroesophageal Adenocarcinoma	PHASE2	RECRUITING	UNICANCER	—	Surrogate endpoint only Single country
NCT06138223	The Effect of exeRcise And Diet on Quality of Life in Patients With Incurable Cancer of Esophagus and Stomach (RADICES)	NA	RECRUITING	Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)	—	Single country
NCT06819566	Prophylactic Endoscopic Variceal Ligation in Patients With High-risk Esophageal Varices Receiving Atezo/Bev for HCC	PHASE2	RECRUITING	Asan Medical Center	—	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 — No regimen components on this track — availability unknown	— unknown	— unknown	₴-? — verify pathway	not recorded
Trial · NCT07487896 A Study of YL201 Versus Investigator's Choice of Chemotherapy in Participants With Locally Advanced or Metastatic Esophageal Squamous Cell Carcinoma After Failure of First-Line Therapy No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06199895 Clinical Efficacy and Safety of Paclitaxel Polymeric Micelles for Injection in the Treatment of Patients With Taxans-resistant Pancreatic Adenocarcinoma, Cholangiocarcinoma, Lung Cancer, Gastric Cancer, Esophageal Carcinoma, or Breast Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT02972372 Chemoradiation Versus Esophagectomy for Locally Advanced Esophageal Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06346080 Molecular Analysis for Gastro-Esophageal Cancer: Multicenter Discrete Choice Experiment No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06435286 Effectiveness and Performance of an Optical Biopsy Technology for Esophageal Cancer in Brazil and the United States No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05173246 JS001 Combined With TP as First-line Treatment for Unresectable or Advanced Small Cell Esophageal Carcinoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06569459 Trilaciclib Combined With Concurrent Chemoradiotherapy and Immunotherapy in the Treatment of Esophageal Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06846346 Testing Ivonescimab in Combination With Chemotherapy in Advanced or Metastatic Gastric/Gastroesophageal Adenocarcinoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06138223 The Effect of exeRcise And Diet on Quality of Life in Patients With Incurable Cancer of Esophagus and Stomach (RADICES) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06819566 Prophylactic Endoscopic Variceal Ligation in Patients With High-risk Esophageal Varices Receiving Atezo/Bev for HCC 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-ESOPHAGEAL-001-V1 | version: 1 | generated: 2026-07-26T09:28:48.433259+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.