OpenOnco
UA EN
Plan Builder Prevention Onco Wiki Tumor Board
OpenOnco · DIS-CRC · BIO-DMMR-IHC (ESCAT IA)
← Back to galleryFeedback on this case
Synthetic educational example. Do not self-treat: a qualified treating physician must verify the sources, patient data, contraindications, and final plan.
OpenOnco · Treatment Plan
Treatment plan — Colorectal carcinoma
PLAN-BMA-EPCAM_GERMLINE_CRC-V1 · v1 · 2026-08-17
Patient
BMA-EPCAM_GERMLINE_CRC · 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
✅ Covered biomarkers (matched in KB)
BiomarkerVariantESCATEvidenceClinical significanceDrugsSources
No clinically actionable variants matched in this profile.
⚠️ Not included in plan
BiomarkerStatus
BIO-DMMR-IHCBIO definition in KB; no ESCAT BMA entry — verify with clinician

Primary current-line option

Standard plan
★ DEFAULT
Indication
IND-CRC-ADJUVANT-STAGE2-HIGHRISK-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
Provisional current-line default from ALGO-CRC-ADJUVANT: step 1 did not select a treatment branch. Stage I — observation; Stage IV — metastatic algorithm applies.

Other current-line alternatives (2 tracks)

Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.
Standard plan
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
Current-line alternative presented for HCP consideration
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-STAGE2-HIGHRISK-FOLFOX)
  • Do NOT offer adjuvant chemo to dMMR/MSI-H stage II — no benefit, possible harm
  • Do NOT delay adjuvant beyond 8 weeks post-surgery
  • Do NOT add bevacizumab — NSABP C-08 negative
  • Do NOT continue oxaliplatin past Grade 2 functional neuropathy — switch to 5-FU/LV
  • Do NOT apply IDEA 3-month CAPOX data to FOLFOX (not interchangeable for duration reduction)
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).
Specialistskill_idVersionLast reviewedSign-offsDomain
Cellular therapy specialist (CAR-T)cellular_therapy_specialistv0.1.02026-04-250cellular_therapy
Clinical pharmacistclinical_pharmacistv0.1.02026-04-250clinical_pharmacy
Hematologist / oncohematologisthematologistv0.1.02026-04-250hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)hematopathologistv0.1.02026-04-250hematopathology
Infectious disease / hepatologyinfectious_disease_hepatologyv0.1.02026-04-250infectious_diseases
Medical oncologist (solid-tumor chemotherapist)medical_oncologistv0.1.02026-04-250solid_oncology
Molecular geneticist / molecular oncologistmolecular_geneticistv0.1.02026-04-250molecular_oncology
Palliative carepalliative_carev0.1.02026-04-250palliative_care
Pathologist (general)pathologistv0.1.02026-04-250pathology
Primary care / family physicianprimary_carev0.1.02026-04-250primary_care
Psycho-oncologistpsychologistv0.1.02026-04-250psychosocial
Radiation oncologistradiation_oncologistv0.1.02026-04-250radiation_oncology
Radiologistradiologistv0.1.02026-04-250diagnostic_imaging
Social worker / case managersocial_worker_case_managerv0.1.02026-04-250psychosocial
Surgical oncologistsurgical_oncologistv0.1.02026-04-250surgical_oncology
Transplant specialist (BMT)transplant_specialistv0.1.02026-04-250cellular_therapy

Sources cited

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: 2026-08-17.
NCTTitlePhaseStatusSponsorUASignalsEligibility (excerpt)
NCT06865638Efficacy and Safety of Colorectal Anastomotic Leak TestingNARECRUITINGNanchong Central Hospital—Single country
NCT07629960A First-in-Human Trial of BLU-924 (SAR449336) in Advanced Solid Tumors Harboring KRAS MutationsPHASE1 / PHASE2RECRUITINGBlueprint Medicines Corporation—Surrogate endpoint only Single country
NCT06980532Glumetinib Combined With Fruquintinib in the Treatment of MET Amplification or Protein Overexpression in Third-Line Unresectable Metastatic Colorectal CancerPHASE1 / PHASE2RECRUITINGLiu Huang—Small N (<50) Surrogate endpoint only Single country
NCT06314958Stage II/III Colorectal Cancer RecurrenceN/ARECRUITINGCity of Hope Medical Center——
NCT06821048Study of CEA Targeting CAR-T (PTC13) in the Treatment of CEA-Positive Advanced Malignant Solid TumorsPHASE1RECRUITINGWeijia Fang, MD—Phase 1 only Small N (<50) Single country
NCT07263178A Study of Second- and Later-line Palliative Chemotherapy in Patients With Metastatic Colorectal Cancer.N/ARECRUITINGBoryung Pharmaceutical Co., Ltd—Surrogate endpoint only Single country
NCT06349590Manipulation of the Gut Microbiome by a Standardized Preoperative Diet to Prevent Colorectal Cancer Recurrence and Metastasis Following SurgeryPHASE1 / PHASE2RECRUITINGUniversity of Chicago—Single country
NCT07244835A Study of DEG6498 in Participants With Solid TumorsPHASE1RECRUITINGDegron Therapeutics Co.—Phase 1 only Single country
NCT07595874Neoadjuvant Botensilimab and Balstilimab for the Treatment of Advanced Resectable Colorectal Cancer NEST3PHASE2RECRUITINGCity of Hope Medical Center—Surrogate endpoint only Single country
NCT07087561Short-Term Nutritional Enhancement Combined With Health Education in Postoperative Colorectal Cancer Patients: A Randomized Controlled TrialNARECRUITINGXiaoqin Luo—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).
OptionUA registrationNSZUCost orientationAccess pathway
Standard plan
FOLFOX (mFOLFOX6) (REG-FOLFOX)
✓ registered✓ covered₴-? — verify pathwayNSZU formulary
Standard plan
FOLFOX (mFOLFOX6) (REG-FOLFOX)
✓ registered✓ covered₴-? — verify pathwayNSZU formulary
Standard plan
CAPOX (XELOX) (REG-CAPOX)
✓ registered✓ covered₴-? — verify pathwayNSZU formulary
Trial · NCT06865638
Efficacy and Safety of Colorectal Anastomotic Leak Testing
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07629960
A First-in-Human Trial of BLU-924 (SAR449336) in Advanced Solid Tumors Harboring KRAS Mutations
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06980532
Glumetinib Combined With Fruquintinib in the Treatment of MET Amplification or Protein Overexpression in Third-Line Unresectable Metastatic Colorectal Cancer
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06314958
Stage II/III Colorectal Cancer Recurrence
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06821048
Study of CEA Targeting CAR-T (PTC13) in the Treatment of CEA-Positive Advanced Malignant Solid Tumors
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07263178
A Study of Second- and Later-line Palliative Chemotherapy in Patients With Metastatic Colorectal Cancer.
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06349590
Manipulation of the Gut Microbiome by a Standardized Preoperative Diet to Prevent Colorectal Cancer Recurrence and Metastasis Following Surgery
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07244835
A Study of DEG6498 in Participants With Solid Tumors
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07595874
Neoadjuvant Botensilimab and Balstilimab for the Treatment of Advanced Resectable Colorectal Cancer NEST3
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07087561
Short-Term Nutritional Enhancement Combined With Health Education in Postoperative Colorectal Cancer Patients: A Randomized Controlled Trial
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: 2026-08-17.

plan_id: PLAN-BMA-EPCAM_GERMLINE_CRC-V1 | version: 1 | generated: 2026-08-17T08:06:31.683336+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.