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OpenOnco · Cervical · Locally Advanced (CCRT + Pembrolizumab)
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OpenOnco · Treatment Plan
Treatment plan — Cervical carcinoma
PLAN-CERV-LA-001-V1 · v1 · 2026-09-09
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: 2026-09-09.
NCTTitlePhaseStatusSponsorUASignalsEligibility (excerpt)
NCT06860971A Study of AL2846 Capsule Versus Placebo in the Treatment of Advanced Radioiodine-Refractory Differentiated Thyroid CarcinomaPHASE3RECRUITINGChia Tai Tianqing Pharmaceutical Group Co., Ltd.—Surrogate endpoint only Single country
NCT07512921Matching Primary Tumor and Blood Gene Expression Analysis of HPV-negative Squamous Head and Neck CancersN/ARECRUITINGFondazione IRCCS Istituto Nazionale dei Tumori, Milano—Single country
NCT07717307Study Comparing Limited and Extensive Neck Surgery in Oral Cancer Patients With Neck SpreadNARECRUITINGKolhapur Cancer Centre - Cancer Centers of America—Single country
NCT07137052Precise Guidance of Adaptive Radiotherapy for Nasopharyngeal CarcinomaN/ARECRUITINGThe First Affiliated Hospital of Xiamen University—Surrogate endpoint only Single country
NCT07101744Iparomlimab and Tuvonralimab Combined With Nimotuzumab in Recurrent or Metastatic NPC After First-line Treatment Failure: A Single-arm Phase IIa Clinical TrialPHASE2RECRUITINGSun Yat-sen University—Small N (<50) Surrogate endpoint only Single country
NCT04135664Comparison of Esophagectomy and Chemoradiation for Patients With cN0-pT1b Stage Esophageal Squamous Cell CarcinomaPHASE3RECRUITINGShanghai Chest Hospital—Single country
NCT03975322Prediction of Malignant Transformation of Oral Leukoplakia Using a MAGE-A-based ImmunoscoreN/ARECRUITINGUniversity of Erlangen-Nürnberg Medical School—Single country
NCT07376837Radiofrequency Ablation for Curative Treatment of Small Low-Risk Papillary Thyroid Cancer: Pilot StudyNARECRUITINGUniversity Health Network, Toronto—Small N (<50) Single country
NCT07232654Iparomlimab/Tuvonralimab Injection Plus CCRT in LACCPHASE2RECRUITINGCancer Institute and Hospital, Chinese Academy of Medical Sciences—Small N (<50) Surrogate endpoint only Single country
NCT06343870Estradiol and Testosterone Subdermal Implants for Menopause Treatment (ESTIME)PHASE3RECRUITINGUniversity of Sao Paulo General Hospital—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 · NCT06860971
A Study of AL2846 Capsule Versus Placebo in the Treatment of Advanced Radioiodine-Refractory Differentiated Thyroid Carcinoma
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07512921
Matching Primary Tumor and Blood Gene Expression Analysis of HPV-negative Squamous Head and Neck Cancers
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07717307
Study Comparing Limited and Extensive Neck Surgery in Oral Cancer Patients With Neck Spread
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07137052
Precise Guidance of Adaptive Radiotherapy for Nasopharyngeal Carcinoma
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07101744
Iparomlimab and Tuvonralimab Combined With Nimotuzumab in Recurrent or Metastatic NPC After First-line Treatment Failure: A Single-arm Phase IIa Clinical Trial
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT04135664
Comparison of Esophagectomy and Chemoradiation for Patients With cN0-pT1b Stage Esophageal Squamous Cell Carcinoma
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT03975322
Prediction of Malignant Transformation of Oral Leukoplakia Using a MAGE-A-based Immunoscore
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07376837
Radiofrequency Ablation for Curative Treatment of Small Low-Risk Papillary Thyroid Cancer: Pilot Study
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07232654
Iparomlimab/Tuvonralimab Injection Plus CCRT in LACC
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06343870
Estradiol and Testosterone Subdermal Implants for Menopause Treatment (ESTIME)
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: 2026-09-09.

plan_id: PLAN-CERV-LA-001-V1 | version: 1 | generated: 2026-09-09T12:26:41.426308+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.