OpenOnco
UA EN
Plan Builder Prevention Onco Wiki Tumor Board
OpenOnco · DIS-CERVICAL · BIO-PDL1-CPS (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 — Cervical carcinoma
PLAN-BMA-PDL1_CPS_CERVICAL-V1 · v1 · 2026-08-03
Patient
BMA-PDL1_CPS_CERVICAL · Algorithm: ALGO-CERVICAL-METASTATIC-1L
DiagnosisCervical carcinoma
MOH / ICD-10C53
ICD-O-38070/3; C53

Etiological driver

Etiological driver · etiologically_driven archetype
Cervical carcinoma
  • High-risk HPV chronic infection (genotypes 16, 18, 31, 33, 45, 52, 58 — accounts for >99% of cases)
  • HIV co-infection (immunosuppression accelerates progression)
  • Smoking (cofactor for SCC)
  • Long-term oral contraceptives (modest cofactor for adenocarcinoma)
  • Multiple sexual partners + early coitarche (HPV transmission risk)

Clinical significance of mutations (ESCAT)

Tumor-board context — the engine does not use these tiers to rank tracks
BiomarkerVariantESCATEvidenceClinical significanceDrugsSources
ESCAT: clinical review pendingBIO-PDL1-CPS(gene-level)IA
  • SRC-NCCN-CERVICAL-2025
  • SRC-ESMO-CERVICAL-2024
  • SRC-KEYNOTE-826-COLOMBO-2021
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 ≥1 is required for pembrolizumab in persistent/recurrent/metastatic cervical cancer (KEYNOTE-826): pembrolizumab + paclitaxel + cisplatin/carboplatin ± bevacizumab 1L (CPS≥1 mOS 28.6 mo vs 16.5 mo, HR 0.64). FDA-approved 2021. Testing by IHC 22C3 pharmDx. Threshold-gated indication selection performed by the algorithm layer (IND-CERVICAL-METASTATIC-1L-PEMBRO-CHEMO-BEV); this BMA entry surfaces ESCAT context only.pembrolizumab + paclitaxel + cisplatin/carboplatin ± bevacizumab (CPS≥1 1L per SRC-NCCN-CERVICAL-2025, SRC-ESMO-CERVICAL-2024, SRC-KEYNOTE-826-COLOMBO-2021)
  • SRC-NCCN-CERVICAL-2025
  • SRC-ESMO-CERVICAL-2024
  • SRC-KEYNOTE-826-COLOMBO-2021

Primary current-line option

Standard plan
★ DEFAULT
Indication
IND-CERVICAL-METASTATIC-1L-PEMBRO-CHEMO-BEV
Regimen
Pembrolizumab + paclitaxel + carboplatin ± bevacizumab (cervical cancer, 1L)
Drugs + NSZU
  • Pembrolizumab (DRUG-PEMBROLIZUMAB) 200 mg IV q3w · Until progression or max 35 cycles (~2 years) · IV ⚠ NSZU — not for this indication
  • Paclitaxel (DRUG-PACLITAXEL) 175 mg/m² IV over 3h · Day 1 q3w; typically 6 cycles then pembro maintenance · IV ⚠ NSZU — not for this indication
  • Carboplatin (DRUG-CARBOPLATIN) AUC 5 IV · Day 1 q3w with paclitaxel · IV ⚠ NSZU — not for this indication
  • Bevacizumab (DRUG-BEVACIZUMAB) 15 mg/kg IV (optional — if no contraindication) · Day 1 q3w; continue with pembro maintenance after chemo · IV ⚠ NSZU — not for this indication
Reason
Provisional current-line default from ALGO-CERVICAL-METASTATIC-1L: step 1 did not select a treatment branch. Locally advanced FIGO IB3-IVA with curative intent → ALGO-CERVICAL-LOCALLY-ADVANCED-1L.

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track
  • Patient with active or incompletely controlled pre-existing autoimmune or inflammatory disease (sarcoidosis, rheumatoid arthritis, IBD, SLE, autoimmune hepatitis, inflammatory myopathy, myasthenia gravis, or similar) is considered for immune checkpoint inhibitor (ICI) therapy — elevated risk of immune-related adverse events (irAE) flare or de-novo grade 3-4 irAE. Requires specialist (rheumatology / pulmonology / gastroenterology) pre-treatment review; prefer lower-irAE-burden backbone when options exist (pembrolizumab mono > ipilimumab+nivolumab).
    Pre-existing autoimmune disease is present in ~10-15% of patients eligible for ICI therapy; historically excluded from pivotal trials. Real-world data (Abdel-Wahab 2018, 3557 pts) shows 55% experienced irAE flare and ~29% required…
    RF-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISKSRC-SITC-ICI-IRAEMANAGEMENT-2021SRC-ESMO-ICI-TOXICITY-2022
  • Frailty profile precluding standard cisplatin-based chemoradiation in cervical cancer: ECOG ≥3, OR (age ≥75 with Charlson ≥3), OR composite (age ≥70 + albumin <3.0 + ≥2 comorbidities). Routes to carboplatin-CRT substitution or RT-alone (less efficacy but tolerable).
    Cisplatin radiosensitizer requires CrCl ≥60 — elderly often fall below. Carboplatin-CRT (AUC 2 weekly) is acceptable substitute when cisplatin intolerable, though less radiosensitizing per non-randomized comparisons. Frail elderly with…
    RF-CERVICAL-FRAILTY-AGESRC-NCCN-CERVICAL-2025SRC-ESMO-CERVICAL-2024
  • Hydronephrosis or pelvic-mass-induced ureteric obstruction in cervical cancer (FIGO IIIB by definition). Mandates urgent renal decompression (percutaneous nephrostomy or ureteric stent) BEFORE cisplatin-based CRT — cisplatin nephrotoxic + ureteric obstruction worsens AKI.
    FIGO IIIB definition includes hydronephrosis from tumor — substantial prognostic weight. Cisplatin radiosensitization needs CrCl ≥60; decompression first, restage CrCl, then proceed with CRT.
    RF-CERVICAL-HYDRONEPHROSIS-PELVIC-OBSTRUCTIONSRC-NCCN-CERVICAL-2025SRC-ESMO-CERVICAL-2024
  • Active or unmanaged infection requiring resolution before initiating cisplatin-based chemoradiation in cervical cancer: HIV-positive (HPV-driven disease — almost universal HIV testing recommended; CD4 informs cisplatin dosing and pelvic-RT field tolerance), HBV-positive (reactivation risk on prolonged chemoradiation), active pelvic abscess / pyometra (must drain before RT), or active TB.
    HIV testing recommended for all cervical cancer patients per NCCN (HPV / HIV co-infection extremely common). HIV+ patients tolerate cisplatin-CRT with ART optimization; CD4 <200 is relative contraindication — coordinate with HIV clinic…
    RF-CERVICAL-INFECTION-SCREENINGSRC-NCCN-CERVICAL-2025SRC-ESMO-CERVICAL-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-CERVICAL-METASTATIC-1L-PEMBRO-CHEMO-BEV)
  • Do not prescribe bevacizumab in patients with active fistulas, untreated hypertension, proteinuria >2+, or history of perforation — risk of perforation / bleeding
  • Do not skip PD-L1 CPS testing — affects 1L choice
  • Do not start pembrolizumab without HBV/HCV/HIV screening + baseline thyroid

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Pembrolizumab + paclitaxel + carboplatin ± bevacizumab (cervical cancer, 1L)
21-day cycles × 6 cycles full combination; then pembro ± bev maintenance until progression or max 35 pembro cycles

MDT brief

Discussion questions (1, 1 blocking)

  • BLOCKING OQ-BIOMARKER-PD-L1-CPS
    What is the status of BIO-PD-L1-CPS (BIO-PD-L1-CPS)? It is required by track(s): IND-CERVICAL-METASTATIC-1L-PEMBRO-CHEMO-BEV. Expected value: PD-L1 CPS ≥1 (KEYNOTE-826 enrolled all CPS but benefit greatest at CPS ≥1; FDA-approved indication is CPS ≥1).
    A treatment-track biomarker requirement is missing from the patient profile; the MDT should verify the test result, method, specimen, and date before relying on this option.
    → medical_oncologist

MDT talk tree (1 steps)

#OwnerTopicAction
1medical_oncologistBiomarker status BLOCKINGWhat is the status of BIO-PD-L1-CPS (BIO-PD-L1-CPS)? It is required by track(s): IND-CERVICAL-METASTATIC-1L-PEMBRO-CHEMO-BEV. Expected value: PD-L1 CPS ≥1 (KEYNOTE-826 enrolled all CPS but benefit greatest at CPS ≥1; FDA-approved indication is CPS ≥1).

Data quality

Incomplete for default-track review. Default-track review is incomplete until required biomarker gaps are resolved.
  • Biomarker coverage: 0/1 known (0%), 1 missing, 1 default-track gaps
  • Unevaluated RedFlags: RF-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISK, RF-CERVICAL-FRAILTY-AGE, RF-CERVICAL-HIGH-RISK-BIOLOGY, RF-CERVICAL-HYDRONEPHROSIS-PELVIC-OBSTRUCTION, RF-CERVICAL-INFECTION-SCREENING, RF-CERVICAL-PDL1-CPS-1-PLUS, RF-CERVICAL-TRANSFORMATION-PROGRESSION, RF-CHRONIC-HPV-MALIGNANCY-PREVENTION, RF-IATROGENIC-DES-EXPOSURE-PREVENTION, RF-IATROGENIC-LONG-TERM-HRMNL-CONTRACEPTION-PREVENTION, RF-IATROGENIC-TRANSPLANT-IMMUNOSUPPRESSION-LONGTERM-PREVENTION, RF-IATROGENIC-TRANSPLANT-IMMUNOSUPPRESSION-PREVENTION, RF-PEUTZ-JEGHERS-CONFIRMED-CARRIER, RF-PEUTZ-JEGHERS-FAMILY-HISTORY-SUSPICION, RF-REPRODUCTIVE-DES-IN-UTERO-EXPOSURE-PREVENTION, RF-REPRODUCTIVE-HIGH-PARITY-CERVICAL-PREVENTION, RF-REPRODUCTIVE-OCP-LONG-TERM
Missing biomarkerLabelMDT ownerDefault trackRequired byNext action
BIO-PD-L1-CPSBIO-PD-L1-CPSmedical_oncologistyesIND-CERVICAL-METASTATIC-1L-PEMBRO-CHEMO-BEVVerify result, method, specimen, and report date before sign-off. Expected/constraint: PD-L1 CPS ≥1 (KEYNOTE-826 enrolled all CPS but benefit greatest at CPS ≥1; FDA-approved indication is CPS ≥1)
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: 2026-08-03.
NCTTitlePhaseStatusSponsorUASignalsEligibility (excerpt)
NCT06869473Cetuximab Plus Platinum and Taxane-based Chemotherapy, Followed by Avelumab and Cetuximab, as First-line Treatment for Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma (HNSCC) Patients With a PD-L1 Combined Positive Score (CPS)≥1≤19.PHASE2RECRUITINGGruppo Oncologico del Nord-Ovest—Biomarker: unclear Surrogate endpoint only Single country
NCT06998069Head and Neck Cancer Study Project in the Geriatric PopulationPHASE3RECRUITINGBrown University—Small N (<50) Single country
NCT07026474Re-Radiochemotherapy and Pembrolizumab vs. Immuno(Chemo)Therapy for Locoregionally Recurrent PD-L1 Positive (CPS≥1) HNSCCPHASE3RECRUITINGUniversität des Saarlandes——
NCT06601309Biomarker Based Neoadjuvant Strategies for Locally Advanced Resectable ESCCPHASE2RECRUITINGFujian Medical University Union Hospital—Biomarker: unclear Single country
NCT07546383A Study Investigating the Efficacy and Safety of the Combination of Iparomlimab and Tuvonralimab With or Without Chemotherapy in Second-line and Subsequent Treatments for Recurrent or Metastatic Head and Neck Squamous Cell CarcinomaNARECRUITINGThe Second Affiliated Hospital of Hainan Medical University—Small N (<50) Surrogate endpoint only Single country
NCT04999761AB122 Platform StudyPHASE1RECRUITINGTaiho Pharmaceutical Co., Ltd.—Phase 1 only Surrogate endpoint only Single country
NCT06123884BAT1308 Combined with Platinum-Based Chemotherapy± Bevacizumab for PDL1-Positive (CPS ≥1) Cervical CancerPHASE2 / PHASE3RECRUITINGBio-Thera Solutions—Single country
NCT05799144pBI-11 & TA-HPV (With Pembrolizumab as Treatment for Patients w/Advanced, PD-L1 CPS≥1, hrHPV+ Oropharyngeal CancerPHASE2RECRUITINGMichael K. Gibson—Biomarker: unclear Single country
NCT07216703A Clinical Study of Sacituzumab Tirumotecan (MK-2870) in Combination With Pembrolizumab (MK-3475) as First-line Maintenance Treatment of Cervical Cancer (MK-2870-036/TroFuse-036/GOG-3123/ENGOT-cx22)PHASE3RECRUITINGMerck Sharp & Dohme LLC——

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
Pembrolizumab + paclitaxel + carboplatin ± bevacizumab (cervical cancer, 1L) (REG-PEMBRO-PACLI-CARBO-BEV-CERVICAL)
✓ registered✓ covered₴-? — verify pathwayNSZU formulary
Trial · NCT06869473
Cetuximab Plus Platinum and Taxane-based Chemotherapy, Followed by Avelumab and Cetuximab, as First-line Treatment for Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma (HNSCC) Patients With a PD-L1 Combined Positive Score (CPS)≥1≤19.
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06998069
Head and Neck Cancer Study Project in the Geriatric Population
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07026474
Re-Radiochemotherapy and Pembrolizumab vs. Immuno(Chemo)Therapy for Locoregionally Recurrent PD-L1 Positive (CPS≥1) HNSCC
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06601309
Biomarker Based Neoadjuvant Strategies for Locally Advanced Resectable ESCC
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07546383
A Study Investigating the Efficacy and Safety of the Combination of Iparomlimab and Tuvonralimab With or Without Chemotherapy in Second-line and Subsequent Treatments for Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT04999761
AB122 Platform Study
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06123884
BAT1308 Combined with Platinum-Based Chemotherapy± Bevacizumab for PDL1-Positive (CPS ≥1) Cervical Cancer
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT05799144
pBI-11 & TA-HPV (With Pembrolizumab as Treatment for Patients w/Advanced, PD-L1 CPS≥1, hrHPV+ Oropharyngeal Cancer
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07216703
A Clinical Study of Sacituzumab Tirumotecan (MK-2870) in Combination With Pembrolizumab (MK-3475) as First-line Maintenance Treatment of Cervical Cancer (MK-2870-036/TroFuse-036/GOG-3123/ENGOT-cx22)
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: 2026-08-03.

plan_id: PLAN-BMA-PDL1_CPS_CERVICAL-V1 | version: 1 | generated: 2026-08-03T12:01:52.982557+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.