Patient
BMA-NTRK_FUSION_CRC · Algorithm: ALGO-CRC-ADJUVANT
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-NTRK-FUSION | NTRK1/3 fusion (rare ~0.1-0.3%, enriched in MSI-H / dMMR CRC) | IA | - SRC-NCCN-COLON-2025
- SRC-ESMO-COLON-2024
Evidence cited from clinical guidelines; per-source evidence levels not yet structured. See Phase-2-of-CIViC-pivot for re-cite roadmap. | NTRK fusion in CRC is rare (~0.1-0.3%) but enriched in MSI-H / Lynch syndrome CRC (~5-10% of MSI-H). Larotrectinib and entrectinib are FDA tumor-agnostic; CRC subset of pooled trials shows durable responses. Practical detection challenge: pan-TRK IHC has high false-positive rate in MSI-H CRC — confirm with RNA-NGS. | larotrectinib monotherapy
entrectinib monotherapy | - SRC-NCCN-COLON-2025
- SRC-ESMO-COLON-2024
|
Treatment options (3 tracks)
IND-CRC-ADJUVANT-STAGE2-HIGHRISK-FOLFOX
- Indication
- IND-CRC-ADJUVANT-STAGE2-HIGHRISK-FOLFOX
- Regimen
- —
- Reason
- Alternative track presented for HCP consideration
- 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
- Alternative track presented for HCP consideration
IND-CRC-ADJUVANT-STAGE3-CAPOX
- Indication
- IND-CRC-ADJUVANT-STAGE3-CAPOX
- Regimen
- —
- Reason
- Alternative track 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.
RF-CRC-FRAILTY-AGE
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
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
MDT brief
Data quality
- Unevaluated RedFlags: 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-RAS-MUTANT, RF-CRC-RAS-WT, RF-CRC-TRANSFORMATION-PROGRESSION
Skill catalog (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 | Sign-offs | Domain |
|---|
| Cellular therapy specialist (CAR-T) | cellular_therapy_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
| Clinical pharmacist | clinical_pharmacist | v0.1.0 | 2026-04-25 | 0 | clinical_pharmacy |
| Hematologist / oncohematologist | hematologist | v0.1.0 | 2026-04-25 | 0 | hematology_oncology |
| Hematopathologist (lymphoma / leukemia / myeloma) | hematopathologist | v0.1.0 | 2026-04-25 | 0 | hematopathology |
| Infectious disease / hepatology | infectious_disease_hepatology | v0.1.0 | 2026-04-25 | 0 | infectious_diseases |
| Medical oncologist (solid-tumor chemotherapist) | medical_oncologist | v0.1.0 | 2026-04-25 | 0 | solid_oncology |
| Molecular geneticist / molecular oncologist | molecular_geneticist | v0.1.0 | 2026-04-25 | 0 | molecular_oncology |
| Palliative care | palliative_care | v0.1.0 | 2026-04-25 | 0 | palliative_care |
| Pathologist (general) | pathologist | v0.1.0 | 2026-04-25 | 0 | pathology |
| Primary care / family physician | primary_care | v0.1.0 | 2026-04-25 | 0 | primary_care |
| Psycho-oncologist | psychologist | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Radiation oncologist | radiation_oncologist | v0.1.0 | 2026-04-25 | 0 | radiation_oncology |
| Radiologist | radiologist | v0.1.0 | 2026-04-25 | 0 | diagnostic_imaging |
| Social worker / case manager | social_worker_case_manager | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Surgical oncologist | surgical_oncologist | v0.1.0 | 2026-04-25 | 0 | surgical_oncology |
| Transplant specialist (BMT) | transplant_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
Sources cited
- SRC-ESMO-COLON-2024: ESMO CRC Clinical Practice Guideline (2024)
- SRC-NCCN-COLON-2025: NCCN Colon / Rectal Cancer (v.4.2025)
Experimental options (clinical trials)
Last synced: 2026-05-04 · ctgov.
No active trials matched this scenario in ctgov.
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 |
|---|
| IND-CRC-ADJUVANT-STAGE2-HIGHRISK-FOLFOX — No regimen components on this track — availability unknown | — unknown | — unknown | ₴-? — verify pathway | not recorded |
| Standard plan FOLFOX (mFOLFOX6) (REG-FOLFOX) | ✓ registered | ✓ covered | ₴-? — verify pathway | NSZU formulary |
| IND-CRC-ADJUVANT-STAGE3-CAPOX — No regimen components on this track — availability unknown | — unknown | — unknown | ₴-? — verify pathway | not recorded |
Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-05-04.