OpenOnco · Treatment Plan

Treatment plan — Colorectal carcinoma

PLAN-BMA-KRAS_G12C_CRC-V1 · v1 · 2026-08-18

Patient

BMA-KRAS_G12C_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

Biomarker	Variant	ESCAT	Evidence	Clinical significance	Drugs	Sources
ESCAT: clinical review pendingBIO-KRAS-G12C	G12C	IB	Molecular evidence option SRC-CIVIC: Level A (Supports, Sensitivity/Response) SRC-CIVIC: Level B (Supports, Poor Outcome) Resistance or avoidance signal SRC-CIVIC: Level B ⚠ Resistance SRC-CIVIC: Level C ⚠ Resistance SRC-CIVIC: Level D ⚠ Resistance Trial or research option SRC-CIVIC: Level D (Supports, Sensitivity/Response)	KRAS G12C in mCRC (~3-4%): single-agent KRASG12C inhibitors insufficient (intrinsic EGFR feedback). Combination adagrasib + cetuximab (KRYSTAL-1, Yaeger et al. NEJM 2023) ORR 46%, PFS 6.9 mo. Sotorasib + panitumumab (CodeBreaK 300, Fakih et al. NEJM 2023) ORR 26% vs investigator's choice. Both FDA-approved 2024.	adagrasib + cetuximab sotorasib + panitumumab	SRC-NCCN-COLON-2025 SRC-ESMO-COLON-2024

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).

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: 2026-08-18.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT07371273	Comparative Study on the Short- and Long-term Efficacy of Q-ISR, Traditional Sub-ISR, and t-ISR	PHASE2	RECRUITING	Fudan University	—	Surrogate endpoint only Single country
NCT04751435	Developing New Educational Materials About Genetic Testing for a Diverse Group of Cancer Patients	NA	RECRUITING	Memorial Sloan Kettering Cancer Center	—	Single country
NCT04510129	A Multicenter Cancer Biospecimen Collection Study	N/A	RECRUITING	Cofactor Genomics, Inc.	—	Single country
NCT06943820	AK129 Combination Therapy for Advanced Solid Tumors	PHASE1 / PHASE2	RECRUITING	Akeso	—	Surrogate endpoint only Single country
NCT02215889	Partial Liver Segment 2/3 Transplantation Study	PHASE1 / PHASE2	RECRUITING	Oslo University Hospital	—	Small N (<50) Single country
NCT07588386	The Value of Early Postoperative Colonoscopy in The Early Diagnosis of Anastomotic Leakage After Surgery for Low Colorectal Cancer	NA	RECRUITING	Nanchong Central Hospital	—	Single country
NCT07300150	A Study of PT0511 in Participants With KRAS Mutated or Amplified Advanced Solid Tumors	PHASE1	RECRUITING	PAQ Therapeutics, Inc.	—	Phase 1 only
NCT06756672	HPI in Laparoscopic Colorectal Surgery	NA	RECRUITING	National Taiwan University Hospital	—	Single country
NCT06698146	Colorectal Metastasis to Liver Extraction With Auxiliary Transplant and Delayed Resection	N/A	RECRUITING	Northwestern University	—	Single country
NCT07673861	Clinical Utility of ctDNA in Detecting Resistance Mechanisms and Delivering Precision Medicine to Cancer Patients	NA	RECRUITING	Royal Marsden NHS Foundation Trust	—	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 FOLFOX (mFOLFOX6) (REG-FOLFOX)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Standard plan CAPOX (XELOX) (REG-CAPOX)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT07371273 Comparative Study on the Short- and Long-term Efficacy of Q-ISR, Traditional Sub-ISR, and t-ISR No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04751435 Developing New Educational Materials About Genetic Testing for a Diverse Group of Cancer Patients No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04510129 A Multicenter Cancer Biospecimen Collection Study No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06943820 AK129 Combination Therapy for Advanced Solid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT02215889 Partial Liver Segment 2/3 Transplantation Study No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07588386 The Value of Early Postoperative Colonoscopy in The Early Diagnosis of Anastomotic Leakage After Surgery for Low Colorectal Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07300150 A Study of PT0511 in Participants With KRAS Mutated or Amplified Advanced Solid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06756672 HPI in Laparoscopic Colorectal Surgery No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06698146 Colorectal Metastasis to Liver Extraction With Auxiliary Transplant and Delayed Resection No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07673861 Clinical Utility of ctDNA in Detecting Resistance Mechanisms and Delivering Precision Medicine to Cancer Patients 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: 2026-08-18.

plan_id: PLAN-BMA-KRAS_G12C_CRC-V1 | version: 1 | generated: 2026-08-18T07:59:49.274941+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.