OpenOnco · Treatment Plan

Treatment plan — Colorectal carcinoma

PLAN-CRC-MET-3L-REGO-001-V1 · v1 · 2026-06-27

Patient

CRC-MET-3L-REGO-001 · Algorithm: ALGO-CRC-METASTATIC-3L

DiagnosisColorectal carcinoma

MOH / ICD-10C18-C20

ICD-O-38140/3; C18, C19, C20

StageIV

Histologyadenocarcinoma

Clinical significance of mutations (ESCAT)

Tumor-board context — the engine does not use these tiers to rank tracks

✅ Covered biomarkers (matched in KB)

Biomarker	Variant	ESCAT	Evidence	Clinical significance	Drugs	Sources
BIO-RAS-MUTATION	KRAS A146T	IV	Molecular evidence option SRC-CIVIC: Level B (Supports, Poor Outcome) Resistance or avoidance signal SRC-CIVIC: Level A ⚠ Resistance SRC-CIVIC: Level B ⚠ Resistance SRC-CIVIC: Level C ⚠ Resistance SRC-CIVIC: Level D ⚠ Resistance Trial or research option SRC-CIVIC: Level D (Supports, Sensitivity/Response) SRC-CIVIC: Level E (Supports, Sensitivity/Response)	KRAS A146T — rare, anti-EGFR contraindication marker. No targeted therapy.	—	SRC-NCCN-COLON-2025
BIO-RAS-MUTATION	KRAS exon 3 codon 59/61	IA	Molecular evidence option SRC-CIVIC: Level B (Supports, Poor Outcome) Resistance or avoidance signal SRC-CIVIC: Level A ⚠ Resistance SRC-CIVIC: Level B ⚠ Resistance SRC-CIVIC: Level C ⚠ Resistance SRC-CIVIC: Level D ⚠ Resistance Trial or research option SRC-CIVIC: Level D (Supports, Sensitivity/Response) SRC-CIVIC: Level E (Supports, Sensitivity/Response)	KRAS exon 3 codon 59/61 in mCRC — extended-RAS WT criterion fails; anti-EGFR (cetuximab/panitumumab) contraindicated. Standard chemo ± bevacizumab.	—	SRC-NCCN-COLON-2025 SRC-ESMO-COLON-2024
BIO-RAS-MUTATION	KRAS exon 4 codon 117/146	IA	Molecular evidence option SRC-CIVIC: Level B (Supports, Poor Outcome) Resistance or avoidance signal SRC-CIVIC: Level A ⚠ Resistance SRC-CIVIC: Level B ⚠ Resistance SRC-CIVIC: Level C ⚠ Resistance SRC-CIVIC: Level D ⚠ Resistance Trial or research option SRC-CIVIC: Level D (Supports, Sensitivity/Response) SRC-CIVIC: Level E (Supports, Sensitivity/Response)	KRAS exon 4 codon 117/146 in mCRC — extended-RAS WT criterion fails; anti-EGFR (cetuximab/panitumumab) contraindicated. Standard chemo ± bevacizumab.	—	SRC-NCCN-COLON-2025 SRC-ESMO-COLON-2024
BIO-RAS-MUTATION	KRAS G12D	IV	Molecular evidence option SRC-CIVIC: Level B (Supports, Better Outcome) Resistance or avoidance signal SRC-CIVIC: Level A ⚠ Resistance SRC-CIVIC: Level B ⚠ Resistance SRC-CIVIC: Level C ⚠ Resistance SRC-CIVIC: Level D ⚠ Resistance Trial or research option SRC-CIVIC: Level C (Supports, Sensitivity/Response) SRC-CIVIC: Level D (Supports, Sensitivity/Response) SRC-CIVIC: Level E (Supports, Sensitivity/Response)	KRAS G12D in mCRC predicts anti-EGFR resistance. No approved targeted therapy 2026; trial-only (MRTX1133, RMC-9805 + cetuximab combos).	—	SRC-NCCN-COLON-2025
BIO-RAS-MUTATION	KRAS G12V	IV	Molecular evidence option SRC-CIVIC: Level B (Supports, Poor Outcome) Resistance or avoidance signal SRC-CIVIC: Level A ⚠ Resistance SRC-CIVIC: Level B ⚠ Resistance SRC-CIVIC: Level C ⚠ Resistance SRC-CIVIC: Level D ⚠ Resistance Trial or research option SRC-CIVIC: Level D (Supports, Sensitivity/Response) SRC-CIVIC: Level E (Supports, Sensitivity/Response)	KRAS G12V in mCRC — anti-EGFR contraindication marker, no targeted therapy. Standard chemo ± anti-VEGF.	—	SRC-NCCN-COLON-2025
BIO-RAS-MUTATION	KRAS G12 (any)	IA	Molecular evidence option SRC-CIVIC: Level B (Supports, Poor Outcome) Resistance or avoidance signal SRC-CIVIC: Level A ⚠ Resistance SRC-CIVIC: Level B ⚠ Resistance SRC-CIVIC: Level C ⚠ Resistance SRC-CIVIC: Level D ⚠ Resistance Trial or research option SRC-CIVIC: Level D (Supports, Sensitivity/Response) SRC-CIVIC: Level E (Supports, Sensitivity/Response)	KRAS G12 (any) in mCRC — extended-RAS WT criterion fails; anti-EGFR (cetuximab/panitumumab) contraindicated. Standard chemo ± bevacizumab.	—	SRC-NCCN-COLON-2025 SRC-ESMO-COLON-2024
BIO-RAS-MUTATION	KRAS G13D	IV	Molecular evidence option SRC-CIVIC: Level B (Supports, Poor Outcome) Resistance or avoidance signal SRC-CIVIC: Level A ⚠ Resistance SRC-CIVIC: Level B ⚠ Resistance SRC-CIVIC: Level C ⚠ Resistance SRC-CIVIC: Level D ⚠ Resistance Trial or research option SRC-CIVIC: Level D (Supports, Sensitivity/Response) SRC-CIVIC: Level E (Supports, Sensitivity/Response)	KRAS G13D in mCRC — historical signal of partial cetuximab response (De Roock 2010) was not confirmed prospectively. Treat as RAS-mut, anti-EGFR contraindicated.	—	SRC-NCCN-COLON-2025
BIO-RAS-MUTATION	KRAS G13 (any non-G13C)	IA	Molecular evidence option SRC-CIVIC: Level B (Supports, Poor Outcome) Resistance or avoidance signal SRC-CIVIC: Level A ⚠ Resistance SRC-CIVIC: Level B ⚠ Resistance SRC-CIVIC: Level C ⚠ Resistance SRC-CIVIC: Level D ⚠ Resistance Trial or research option SRC-CIVIC: Level D (Supports, Sensitivity/Response) SRC-CIVIC: Level E (Supports, Sensitivity/Response)	KRAS G13 (any non-G13C) in mCRC — extended-RAS WT criterion fails; anti-EGFR (cetuximab/panitumumab) contraindicated. Standard chemo ± bevacizumab.	—	SRC-NCCN-COLON-2025 SRC-ESMO-COLON-2024
BIO-RAS-MUTATION	KRAS Q61 (any)	IA	Molecular evidence option SRC-CIVIC: Level B (Supports, Poor Outcome) Resistance or avoidance signal SRC-CIVIC: Level A ⚠ Resistance SRC-CIVIC: Level B ⚠ Resistance SRC-CIVIC: Level C ⚠ Resistance SRC-CIVIC: Level D ⚠ Resistance Trial or research option SRC-CIVIC: Level D (Supports, Sensitivity/Response) SRC-CIVIC: Level E (Supports, Sensitivity/Response)	KRAS Q61 (any) in mCRC — extended-RAS WT criterion fails; anti-EGFR (cetuximab/panitumumab) contraindicated. Standard chemo ± bevacizumab.	—	SRC-NCCN-COLON-2025 SRC-ESMO-COLON-2024
BIO-RAS-MUTATION	NRAS G12	IB	Molecular evidence option SRC-CIVIC: Level B (Supports, N/A) Resistance or avoidance signal SRC-CIVIC: Level A ⚠ Resistance SRC-CIVIC: Level B ⚠ Resistance SRC-CIVIC: Level C ⚠ Resistance SRC-CIVIC: Level D ⚠ Resistance Trial or research option SRC-CIVIC: Level D (Supports, Sensitivity/Response)	NRAS codon 12 mutation in mCRC — extended RAS WT criterion fails; anti-EGFR contraindicated.	—	SRC-NCCN-COLON-2025
BIO-RAS-MUTATION	NRAS G13	IB	Molecular evidence option SRC-CIVIC: Level B (Supports, N/A) Resistance or avoidance signal SRC-CIVIC: Level A ⚠ Resistance SRC-CIVIC: Level B ⚠ Resistance SRC-CIVIC: Level C ⚠ Resistance SRC-CIVIC: Level D ⚠ Resistance Trial or research option SRC-CIVIC: Level D (Supports, Sensitivity/Response)	NRAS codon 13 in mCRC — anti-EGFR contraindicated.	—	SRC-NCCN-COLON-2025
BIO-RAS-MUTATION	NRAS Q61K	IB	Molecular evidence option SRC-CIVIC: Level B (Supports, N/A) Resistance or avoidance signal SRC-CIVIC: Level A ⚠ Resistance SRC-CIVIC: Level B ⚠ Resistance SRC-CIVIC: Level C ⚠ Resistance SRC-CIVIC: Level D ⚠ Resistance Trial or research option SRC-CIVIC: Level C (Supports, Sensitivity/Response) SRC-CIVIC: Level D (Supports, Sensitivity/Response)	NRAS Q61K in mCRC — anti-EGFR contraindication.	—	SRC-NCCN-COLON-2025
BIO-RAS-MUTATION	NRAS Q61R	IB	Molecular evidence option SRC-CIVIC: Level B (Supports, N/A) Resistance or avoidance signal SRC-CIVIC: Level A ⚠ Resistance SRC-CIVIC: Level B ⚠ Resistance SRC-CIVIC: Level C ⚠ Resistance SRC-CIVIC: Level D ⚠ Resistance Trial or research option SRC-CIVIC: Level C (Supports, Sensitivity/Response) SRC-CIVIC: Level D (Supports, Sensitivity/Response)	NRAS Q61R in mCRC — anti-EGFR (cetuximab/panitumumab) contraindication. Standard chemo ± bev; no NRAS-selective drug.	—	SRC-NCCN-COLON-2025 SRC-ESMO-COLON-2024

⚠️ Not included in plan

Biomarker	Status
BIO-MSI-STATUS	BIO definition in KB; no ESCAT BMA entry — verify with clinician
BIO-BRAF-V600E	Excluded (negative)
KRAS	Not in KB — ask clinician to verify

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-CRC-METASTATIC-3L-TAS102-BEV

Regimen

Trifluridine-Tipiracil + Bevacizumab (SUNLIGHT) — 3L+ mCRC

Drugs + NSZU

Trifluridine + Tipiracil (DRUG-TRIFLURIDINE-TIPIRACIL) 35 mg/m² PO BID (based on FTD component) · Days 1-5 + 8-12 of each 28-day cycle (4 doses/week × 2 weeks, then 14-day rest) · PO ⚠ Out-of-pocket
Bevacizumab (DRUG-BEVACIZUMAB) 5 mg/kg · IV days 1, 15 of each 28-day cycle · IV ✓ NSZU covered

Supportive care

SUP-GCSF-NEUTROPENIA

Reason

Primary current-line option selected by ALGO-CRC-METASTATIC-3L at step 1.

Other current-line alternatives (2 tracks)

Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.

Aggressive plan

Indication

IND-CRC-METASTATIC-3L-REGORAFENIB

Regimen

Regorafenib monotherapy (CORRECT-style; ReDOS escalation preferred)

Drugs + NSZU

Regorafenib (DRUG-REGORAFENIB) ReDOS escalation: 80 mg PO daily week 1 → 120 mg week 2 → 160 mg week 3 if tolerated; days 1-21 of each 28-day cycle (3 weeks on, 1 week off). Standard CORRECT dose: 160 mg PO daily days 1-21. · PO daily days 1-21 of each 28-day cycle · PO ⚠ NSZU — not for this indication

Reason

Current-line alternative presented for HCP consideration

Standard plan

Indication

IND-CRC-METASTATIC-3L-TRIFLURIDINE-TIPIRACIL-MONO

Regimen

Trifluridine-tipiracil monotherapy (RECOURSE, 3L+ mCRC)

Drugs + NSZU

Trifluridine + Tipiracil (DRUG-TRIFLURIDINE-TIPIRACIL) 35 mg/m² PO BID (rounded to nearest 5 mg) · Days 1-5 + days 8-12 of each 28-day cycle · PO ⚠ Out-of-pocket

Supportive care

SUP-GCSF-NEUTROPENIA

Reason

Current-line alternative presented for HCP consideration

Pre-treatment investigations

Investigations before treatment start · critical / standard / desired · merged across tracks

ID	Name	Priority	Category	Where to order	Needed for
TEST-CBC	Complete Blood Count with Differential	Critical	lab	—	all tracks
TEST-CMP	Comprehensive Metabolic Panel	Critical	lab	—	all tracks
TEST-CT-CHEST-ABDOMEN-PELVIS	CT chest + abdomen + pelvis with IV contrast	Critical	imaging	—	all tracks
TEST-LFT	Liver Function Tests (ALT, AST, bilirubin, ALP, GGT, albumin)	Critical	lab	—	all tracks
TEST-CEA	CEA	Standard	lab	—	all tracks

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-METASTATIC-3L-TAS102-BEV)

Do NOT prescribe with ANC <1500 or platelets <75K at cycle start — myelosuppression likely Grade 3+.
Do NOT escalate dose without count recovery cycle-to-cycle — neutropenia is dose-limiting.
Do NOT initiate bevacizumab within 28 days of major surgery.
Do NOT continue bevacizumab in uncontrolled HTN.
Do NOT use in active hemoptysis / GI bleeding.
Do NOT prescribe with ECOG 3-4 — toxicity profile exceeds frail patient tolerance.
Do NOT confirm the plan without funding pathway for TAS-102.
Do NOT forget to reduce dose when CrCl 30-59 (20 mg/m² BID).

Aggressive plan (IND-CRC-METASTATIC-3L-REGORAFENIB)

Do NOT start at full 160 mg dose — ReDOS escalation (80→120→160) substantially better tolerability.
Do NOT ignore hepatic surveillance — fatal hepatic failure ~1-2%; weekly LFT cycle 1.
Do NOT skip topical urea prophylaxis for HFSR — Grade 3 HFSR is treatment-limiting.
Do NOT combine with anticoagulants without strict monitoring — bleeding risk.
Do NOT continue with uncontrolled HTN >160/100.
Do NOT use in Child-Pugh C — severe hepatic impairment contraindicated.
Do NOT initiate within 2 weeks of major surgery — wound healing impairment.
Do NOT confirm without funding — drug not NSZU-reimbursed.

Standard plan (IND-CRC-METASTATIC-3L-TRIFLURIDINE-TIPIRACIL-MONO)

Do NOT prescribe with ANC <1500 or platelets <75K at cycle start — myelosuppression Grade 3+.
Do NOT escalate dose without count recovery cycle-to-cycle — neutropenia is dose-limiting.
Do NOT forget to reduce dose when CrCl 30-59 (20 mg/m² BID).
Do NOT prescribe when CrCl <30 — insufficient safety data.
Do NOT prescribe with ECOG 3-4 — toxicity profile exceeds frail tolerance.
Do NOT confirm without funding pathway for TAS-102.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Trifluridine-Tipiracil + Bevacizumab (SUNLIGHT) — 3L+ mCRC

28-day cycles × Until progression / unacceptable toxicity

Aggressive plan

Induction · Regorafenib monotherapy (CORRECT-style; ReDOS escalation preferred)

28-day cycles × Until progression / unacceptable toxicity

Standard plan

Induction · Trifluridine-tipiracil monotherapy (RECOURSE, 3L+ mCRC)

28-day cycles × Until progression / unacceptable toxicity

MDT brief

Discussion questions (1, 0 blocking)

OQ-LDH-CURRENT
What is the current LDH? Marker of tumor burden and transformation.
LDH is part of the prognostic indices of indolent lymphomas.
→ hematologist

MDT talk tree (3 steps)

#	Owner	Topic	Action
1	hematologist	Staging / disease burden	What is the current LDH? Marker of tumor burden and transformation.
2	clinical_pharmacist	Specialist review	Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
3	social_worker_case_manager	Specialist review	Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.

Skills (recommended) — for consideration (2)

Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
Social worker / case manager recommended
Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.

Data quality

Usable with caveats. No critical default-track gap was found, but the MDT should review the listed caveats before final sign-off.

Biomarker coverage: 0/0 known (100%), 0 missing, 0 default-track gaps
Unevaluated RedFlags: RF-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISK, RF-COWDEN-CONFIRMED-CARRIER, RF-COWDEN-FAMILY-HISTORY-SUSPICION, RF-CRC-EMERGENCY-OBSTRUCTION-PERFORATION, RF-CRC-FRAILTY-AGE, RF-CRC-HER2-AMP-ACTIONABLE, RF-CRC-INFECTION-SCREENING, RF-CRC-OLIGOMET-LIVER-DEFINITION, RF-CRC-RAS-WT, RF-CRC-TRANSFORMATION-PROGRESSION, RF-FAP-CONFIRMED-CARRIER, RF-FAP-FAMILY-HISTORY-SUSPICION, RF-IBD-CRC-PREVENTION, RF-LIFESTYLE-ALCOHOL-CANCER-PREVENTION, RF-LIFESTYLE-HIGH-RED-MEAT-CRC-PREVENTION, RF-LIFESTYLE-LOW-CALCIUM-VIT-D-CRC-PREVENTION, RF-LIFESTYLE-LOW-FIBER-CRC-PREVENTION, RF-LIFESTYLE-LOW-MEDITERRANEAN-DIET-PREVENTION, RF-LIFESTYLE-OBESITY-CANCER-PREVENTION, RF-LIFESTYLE-PROCESSED-MEAT-PREVENTION, RF-LIFESTYLE-SEDENTARY-PREVENTION, RF-LYNCH-CONFIRMED-CARRIER, RF-LYNCH-FAMILY-HISTORY-SUSPICION, RF-OCC-FIREFIGHTER-PREVENTION, RF-PEUTZ-JEGHERS-CONFIRMED-CARRIER, RF-PEUTZ-JEGHERS-FAMILY-HISTORY-SUSPICION, RF-PSC-CHOLANGIOCARCINOMA-PREVENTION

Technical MDT skill metadata (2/16 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	Domain
Cellular therapy specialist (CAR-T)	`cellular_therapy_specialist`	v0.1.0	2026-04-25	cellular_therapy
Clinical pharmacist	`clinical_pharmacist`	v0.1.0	2026-04-25	clinical_pharmacy
Hematologist / oncohematologist	`hematologist`	v0.1.0	2026-04-25	hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)	`hematopathologist`	v0.1.0	2026-04-25	hematopathology
Infectious disease / hepatology	`infectious_disease_hepatology`	v0.1.0	2026-04-25	infectious_diseases
Medical oncologist (solid-tumor chemotherapist)	`medical_oncologist`	v0.1.0	2026-04-25	solid_oncology
Molecular geneticist / molecular oncologist	`molecular_geneticist`	v0.1.0	2026-04-25	molecular_oncology
Palliative care	`palliative_care`	v0.1.0	2026-04-25	palliative_care
Pathologist (general)	`pathologist`	v0.1.0	2026-04-25	pathology
Primary care / family physician	`primary_care`	v0.1.0	2026-04-25	primary_care
Psycho-oncologist	`psychologist`	v0.1.0	2026-04-25	psychosocial
Radiation oncologist	`radiation_oncologist`	v0.1.0	2026-04-25	radiation_oncology
Radiologist	`radiologist`	v0.1.0	2026-04-25	diagnostic_imaging
Social worker / case manager	`social_worker_case_manager`	v0.1.0	2026-04-25	psychosocial
Surgical oncologist	`surgical_oncologist`	v0.1.0	2026-04-25	surgical_oncology
Transplant specialist (BMT)	`transplant_specialist`	v0.1.0	2026-04-25	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)

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: 2026-06-27.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT06949982	Efficacy And Safety Of Hydroxychloroquine Combined With Methotrexate, Capecitabine And Bevacizumab Vs. Regorafenib In Participants With Refractory Metastatic Colorectal Cancer With Mutations In RAS Genes	PHASE2	RECRUITING	Sergey Orlov, MD	—	Biomarker: enriched Surrogate endpoint only Single country
NCT06226857	Other Oncogene Mutations for Anti-EGFR Efficacy in Patients With Left-sided RAS-wild Type Metastatic Colorectal Cancer	PHASE3	RECRUITING	City Clinical Oncology Hospital No 1	—	Surrogate endpoint only Single country
NCT05845450	Pre-operative Targeted Treatments in Molecularly Selected Resectable Colorectal Cancer (UNICORN)	PHASE2	RECRUITING	Gruppo Oncologico del Nord-Ovest	—	Surrogate endpoint only Single country
NCT04678583	Anatomical Resection of Liver MetAstases iN patIents With RAS-mutated Colorectal Cancer	NA	RECRUITING	Technische Universität Dresden	—	Biomarker: enriched Surrogate endpoint only Single country
NCT06763029	Irinotecan Liposomes Combined with Cetuximab + Vermofenib in First-line Failure of Advanced Colorectal Cancer	PHASE2	RECRUITING	Fudan University	—	Biomarker: enriched Small N (<50) Surrogate endpoint only Single country
NCT06229340	Leflunomide or Combination of MEK Inhibitor and Hydroxychloroquine for Refractory Patients With RAS Mutations	PHASE2	RECRUITING	N.N. Petrov National Medical Research Center of Oncology	—	Biomarker: enriched Small N (<50) Surrogate endpoint only Single country
NCT05379985	Study of RMC-6236 in Patients With Advanced Solid Tumors Harboring Specific Mutations in RAS	PHASE1 / PHASE2	RECRUITING	Revolution Medicines, Inc.	—	Biomarker: enriched Single country
NCT07224815	cfDNA 5mC/5hmC Biomarkers to Predict Chemotherapy Response in Metastatic Colorectal Cancer	N/A	RECRUITING	City of Hope Medical Center	—	Biomarker: enriched Surrogate endpoint only Single country
NCT05861505	COLLISION RELAPSE Trial	PHASE3	RECRUITING	Amsterdam UMC, location VUmc	—	Single country
NCT06449989	Comparison of Molecular-Genetic Concordance of the Primary Tumor and Brain Metastases of Colorectal Cancer	N/A	RECRUITING	Blokhin's Russian Cancer Research Center	—	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).

Option	UA registration	NSZU	Cost orientation	Access pathway
Standard plan Trifluridine-Tipiracil + Bevacizumab (SUNLIGHT) — 3L+ mCRC (REG-TRIFLURIDINE-TIPIRACIL-BEV) 1/2 component drug(s) not on NSZU formulary	✓ registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Aggressive plan Regorafenib monotherapy (CORRECT-style; ReDOS escalation preferred) (REG-REGORAFENIB)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Standard plan Trifluridine-tipiracil monotherapy (RECOURSE, 3L+ mCRC) (REG-TRIFLURIDINE-TIPIRACIL-MONO) 1/1 component drug(s) not on NSZU formulary	✓ registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Trial · NCT06949982 Efficacy And Safety Of Hydroxychloroquine Combined With Methotrexate, Capecitabine And Bevacizumab Vs. Regorafenib In Participants With Refractory Metastatic Colorectal Cancer With Mutations In RAS Genes No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06226857 Other Oncogene Mutations for Anti-EGFR Efficacy in Patients With Left-sided RAS-wild Type Metastatic Colorectal Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05845450 Pre-operative Targeted Treatments in Molecularly Selected Resectable Colorectal Cancer (UNICORN) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04678583 Anatomical Resection of Liver MetAstases iN patIents With RAS-mutated Colorectal Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06763029 Irinotecan Liposomes Combined with Cetuximab + Vermofenib in First-line Failure of Advanced Colorectal Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06229340 Leflunomide or Combination of MEK Inhibitor and Hydroxychloroquine for Refractory Patients With RAS Mutations No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05379985 Study of RMC-6236 in Patients With Advanced Solid Tumors Harboring Specific Mutations in RAS No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07224815 cfDNA 5mC/5hmC Biomarkers to Predict Chemotherapy Response in Metastatic Colorectal Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05861505 COLLISION RELAPSE Trial No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06449989 Comparison of Molecular-Genetic Concordance of the Primary Tumor and Brain Metastases of Colorectal 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: 2026-06-27.

plan_id: PLAN-CRC-MET-3L-REGO-001-V1 | version: 1 | generated: 2026-06-27T09:41:02.773497+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.