OpenOnco · Cervical · Locally Advanced (CCRT + Pembrolizumab)
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OpenOnco · Treatment Plan
Treatment plan — Cervical carcinoma
PLAN-CERV-LA-001-V1 · v1 · 2026-10-24
Patient
CERV-LA-001 · Algorithm: ALGO-CERVICAL-METASTATIC-1L
DiagnosisCervical carcinoma
MOH / ICD-10C53
ICD-O-38070/3; C53
StageFIGO IIIB
Histologysquamous

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
✅ Covered biomarkers (matched in KB)
BiomarkerVariantESCATEvidenceClinical significanceDrugsSources
No clinically actionable variants matched in this profile.
⚠️ Not included in plan
BiomarkerStatus
BIO-HPV-STATUSBIO definition in KB; no ESCAT BMA entry — verify with clinician

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-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: 2026-10-24 · ClinicalTrials.gov.
NCTTitlePhaseStatusSponsorUASignalsEligibility (excerpt)
NCT06017895Doxepin Solution for Alleviation of Stubborn Breakthrough Pain Induced by Swallowing in Patients Receiving Radiotherapy for Nasopharyngeal CarcinomaNARECRUITINGNanfang Hospital, Southern Medical University—Single country
NCT05751512A Study to Evaluate MRG003 vs Cetuximab/Methotrexate in in the Treatment of Patients With RM-SCCHNPHASE3RECRUITINGLepu Biopharma Co., Ltd.—Single country
NCT07858630Radiotherapy Target Volume Delineation in Locally Advanced Esophageal Cancer in the Immunotherapy EraN/ARECRUITINGCancer Institute and Hospital, Chinese Academy of Medical Sciences—Single country
NCT07341737SL-28 for Advanced Solid TumoursPHASE1 / PHASE2RECRUITINGSecond Life Therapeutics—Single country
NCT06064877A Study of Ficlatuzumab in Combination With Cetuximab in Participants With Recurrent or Metastatic (R/M) HPV Negative Head and Neck Squamous Cell CarcinomaPHASE3RECRUITINGAVEO Pharmaceuticals, Inc.——
NCT05775939PET/CT Imaging to Evaluate Cardiac Radiation Damage in Patients With Lung or Esophageal Cancer, EUCLID TrialNARECRUITINGThomas Jefferson University—Small N (<50) Single country
NCT06052839Pulsed Dose Chemotherapy Plus Pembrolizumab in Recurrent/Metastatic HNSCCPHASE2RECRUITINGDan Zandberg—Small N (<50) Surrogate endpoint only Single country
NCT07219212A Study of JNJ-90301900 in Combination With Chemoradiation Therapy in Participants With Locally Advanced Head and Neck Squamous Cell CarcinomaPHASE1RECRUITINGJohnson & Johnson Enterprise Innovation Inc.—Phase 1 only Small N (<50)
NCT06942416Iparomlimab and Tuvonralimab With Chemoradiation for the Treatment of Locally Recurrent and Oligometastatic Cervical CancerPHASE2RECRUITINGShandong Cancer Hospital and Institute—Small N (<50) Surrogate endpoint only Single country
NCT05495152Adjuvant Sintilimab for Locally Advanced Esophageal Squamous Cell CarcinomaPHASE3RECRUITINGHenan Cancer Hospital—Surrogate endpoint only 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
Pembrolizumab + paclitaxel + carboplatin ± bevacizumab (cervical cancer, 1L) (REG-PEMBRO-PACLI-CARBO-BEV-CERVICAL)
✓ registered✓ covered₴-? — verify pathwayNSZU formulary
Trial · NCT06017895
Doxepin Solution for Alleviation of Stubborn Breakthrough Pain Induced by Swallowing in Patients Receiving Radiotherapy for Nasopharyngeal Carcinoma
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT05751512
A Study to Evaluate MRG003 vs Cetuximab/Methotrexate in in the Treatment of Patients With RM-SCCHN
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07858630
Radiotherapy Target Volume Delineation in Locally Advanced Esophageal Cancer in the Immunotherapy Era
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07341737
SL-28 for Advanced Solid Tumours
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06064877
A Study of Ficlatuzumab in Combination With Cetuximab in Participants With Recurrent or Metastatic (R/M) HPV Negative Head and Neck Squamous Cell Carcinoma
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT05775939
PET/CT Imaging to Evaluate Cardiac Radiation Damage in Patients With Lung or Esophageal Cancer, EUCLID Trial
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06052839
Pulsed Dose Chemotherapy Plus Pembrolizumab in Recurrent/Metastatic HNSCC
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07219212
A Study of JNJ-90301900 in Combination With Chemoradiation Therapy in Participants With Locally Advanced Head and Neck Squamous Cell Carcinoma
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06942416
Iparomlimab and Tuvonralimab With Chemoradiation for the Treatment of Locally Recurrent and Oligometastatic Cervical Cancer
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT05495152
Adjuvant Sintilimab for Locally Advanced Esophageal Squamous Cell Carcinoma
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. Table assembled: 2026-10-24. Table assembly does not verify registration, NSZU coverage or prices. Check the currency of these data separately.

plan_id: PLAN-CERV-LA-001-V1 | version: 1 | generated: 2026-10-24T12:07:12.462011+00:00
Project intended-use limits (CHARTER §11 + §15): Outpatient oncology treatment planning to support tumor-board discussion. For independent clinician review; not for autonomous clinical decision-making.
Project intended-use limits (CHARTER §11 + §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.