OpenOnco
UA EN
Plan Builder Prevention Onco Wiki Tumor Board
OpenOnco · Cervical · Locally Advanced (CCRT + Pembrolizumab)
← Back to galleryFeedback on this case
OpenOnco · Treatment Plan
Treatment plan — Cervical carcinoma
PLAN-CERV-LA-001-V1 · v1 · 2026-07-26
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: 2026-07-26.
NCTTitlePhaseStatusSponsorUASignalsEligibility (excerpt)
NCT06662058Remote Audiometry to Monitor for Treatment-Related Hearing Loss in Patients With H&N SCC Receiving Cisplatin and/or RadiationNARECRUITINGEmory University—Single country
NCT06540443Pilot Study of MPB-2043 Enhanced MRI for Nodal Staging in Head and Neck Squamous Cell CarcinomasPHASE1RECRUITINGMegaPro Biomedical Co. Ltd.—Phase 1 only Small N (<50) Single country
NCT06659146Thermotherapy in Addition to SOC Palliative RadiotherapyNARECRUITINGKing's College London—Single country
NCT06199895Clinical Efficacy and Safety of Paclitaxel Polymeric Micelles for Injection in the Treatment of Patients With Taxans-resistant Pancreatic Adenocarcinoma, Cholangiocarcinoma, Lung Cancer, Gastric Cancer, Esophageal Carcinoma, or Breast CancerPHASE2RECRUITINGLiu Huang—Small N (<50) Surrogate endpoint only Single country
NCT06686342PDO Based Drug Sensitive Test in R/M HNSCCN/ARECRUITINGHuashan Hospital—Surrogate endpoint only Single country
NCT07726199Study Comparing Different Neck Treatment Approaches in Patients With Oral Cancer Without Visible Neck SpreadNARECRUITINGKolhapur Cancer Centre - Cancer Centers of America—Single country
NCT06533267Endoscopic Surgery vs. Intensity Modulated Radiotherapy for Stage I Nasopharyngeal Carcinoma.NARECRUITINGSun Yat-sen University—Single country
NCT05950087Study on the Relationship Between Plasma MRD and cfDNA HPV and the Efficacy and Prognosis of Locally Advanced Cervical Cancer After Concurrent ChemoradiotherapyN/ARECRUITINGGuizhou Provincial People's Hospital—Small N (<50) Single country
NCT06079671Study of Volrustomig in Women With High Risk Locally Advanced Cervical Cancer (eVOLVE-Cervical)PHASE3RECRUITINGAstraZeneca—Surrogate endpoint only
NCT06589609Phase 1 Clinical Trial of FluBHPVE6E7 Immunotherapy for HPV16-Associated Oropharyngeal CancerPHASE1RECRUITINGBlueSky Immunotherapies GmbH—Phase 1 only Small N (<50) 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 · NCT06662058
Remote Audiometry to Monitor for Treatment-Related Hearing Loss in Patients With H&N SCC Receiving Cisplatin and/or Radiation
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06540443
Pilot Study of MPB-2043 Enhanced MRI for Nodal Staging in Head and Neck Squamous Cell Carcinomas
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06659146
Thermotherapy in Addition to SOC Palliative Radiotherapy
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06199895
Clinical Efficacy and Safety of Paclitaxel Polymeric Micelles for Injection in the Treatment of Patients With Taxans-resistant Pancreatic Adenocarcinoma, Cholangiocarcinoma, Lung Cancer, Gastric Cancer, Esophageal Carcinoma, or Breast Cancer
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06686342
PDO Based Drug Sensitive Test in R/M HNSCC
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07726199
Study Comparing Different Neck Treatment Approaches in Patients With Oral Cancer Without Visible Neck Spread
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06533267
Endoscopic Surgery vs. Intensity Modulated Radiotherapy for Stage I Nasopharyngeal Carcinoma.
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT05950087
Study on the Relationship Between Plasma MRD and cfDNA HPV and the Efficacy and Prognosis of Locally Advanced Cervical Cancer After Concurrent Chemoradiotherapy
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06079671
Study of Volrustomig in Women With High Risk Locally Advanced Cervical Cancer (eVOLVE-Cervical)
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06589609
Phase 1 Clinical Trial of FluBHPVE6E7 Immunotherapy for HPV16-Associated Oropharyngeal Cancer
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: 2026-07-26.

plan_id: PLAN-CERV-LA-001-V1 | version: 1 | generated: 2026-07-26T09:28:48.286420+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.