OpenOnco · Treatment Plan

Treatment plan — Cervical carcinoma

PLAN-VAR-CERVICAL-FRAIL-V1 · v1 · 2026-06-27

Patient

VAR-CERVICAL-FRAIL · 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

✅ Covered biomarkers (matched in KB)

Biomarker	Variant	ESCAT	Evidence	Clinical significance	Drugs	Sources
No clinically actionable variants matched in this profile.

⚠️ Not included in plan

Biomarker	Status
BIO-HPV-STATUS	BIO 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). RF-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISK
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). RF-CERVICAL-FRAILTY-AGE
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. RF-CERVICAL-HYDRONEPHROSIS-PELVIC-OBSTRUCTION
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. RF-CERVICAL-INFECTION-SCREENING

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 (2 steps)

#	Owner	Topic	Action
1	medical_oncologist	Biomarker status BLOCKING	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).
2	palliative_care	Specialist review	Reduced performance status / decompensated comorbidity — goals-of-care assessment needed.

Skills (recommended) — for consideration (1)

Palliative care recommended
Reduced performance status / decompensated comorbidity — goals-of-care assessment needed.

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-OCP-LONG-TERM

Missing biomarker	Label	MDT owner	Default track	Required by	Next action
`BIO-PD-L1-CPS`	BIO-PD-L1-CPS	medical_oncologist	yes	IND-CERVICAL-METASTATIC-1L-PEMBRO-CHEMO-BEV	Verify 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 (1/16 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-CERVICAL-2024: ESMO Cervical Cancer Clinical Practice Guideline (2024)
SRC-NCCN-CERVICAL-2025: NCCN Cervical Cancer (v.2.2025)

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
NCT05854823	The Efficacy and Safety of De-escalated Postoperative Radiotherapy in Locally Advanced HNSCC With pCR/MPR	NA	RECRUITING	Fifth Affiliated Hospital, Sun Yat-Sen University	—	Small N (<50) Surrogate endpoint only Single country
NCT06872515	Impact of Prehabilitation in Oncology Via Exercise- Esophageal (IMPROVE-Esophageal)	NA	RECRUITING	University of Pittsburgh	—	Small N (<50) Single country
NCT06190782	Local Therapy for Oligometastatic ESCC Patients Treated With PD-1 Inhibitor	PHASE3	RECRUITING	Fudan University	—	Surrogate endpoint only Single country
NCT05872724	Optimization of Postoperative Adjuvant Therapy for Cervical Cancer Based on MRD(Minimal Residual Disease)	PHASE2	RECRUITING	Suzhou Municipal Hospital	—	Small N (<50) Surrogate endpoint only Single country
NCT07106814	Safety and Efficacy of Metabolically Armed Tumor-lnfiltrating Lymphocytes (Meta10-TIL) for the Treatment of Advanced Solid Tumors	EARLY_PHASE1	RECRUITING	Anhui Provincial Hospital	—	Small N (<50) Single country
NCT06287034	The Role of the Free/Pedunculated Flap in Total Laryngectomy After (Chemo-)Radiotherapy Failure for Laryngeal Carcinoma: Impact on the Risk of Pharyngocutaneous Fistula (PCF)	N/A	RECRUITING	Regina Elena Cancer Institute	—	Single country
NCT05544084	Adaptation and Implementation of a Patient Navigation Program for Cervical Cancer Screening Across Contexts in Senegal	NA	RECRUITING	University of Illinois at Chicago	—	Single country
NCT03968406	Talazoparib and Radiation Therapy in Treating Patients With Locally Recurrent Gynecologic Cancers	PHASE1	RECRUITING	M.D. Anderson Cancer Center	—	Phase 1 only Small N (<50) Single country
NCT02838836	Tumor Cell and DNA Detection in the Blood, Urine and Bone Marrow of Patients With Solid Cancers	N/A	RECRUITING	University of Missouri-Columbia	—	Surrogate endpoint only Single country
NCT06529809	Accelerated Brachytherapy Forward Chemo Radiation Therapy (ABC-RT) for Locally-advanced Cervical Cancer	PHASE1 / PHASE2	RECRUITING	Washington University School of Medicine	—	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 Pembrolizumab + paclitaxel + carboplatin ± bevacizumab (cervical cancer, 1L) (REG-PEMBRO-PACLI-CARBO-BEV-CERVICAL)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT05854823 The Efficacy and Safety of De-escalated Postoperative Radiotherapy in Locally Advanced HNSCC With pCR/MPR No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06872515 Impact of Prehabilitation in Oncology Via Exercise- Esophageal (IMPROVE-Esophageal) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06190782 Local Therapy for Oligometastatic ESCC Patients Treated With PD-1 Inhibitor No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05872724 Optimization of Postoperative Adjuvant Therapy for Cervical Cancer Based on MRD(Minimal Residual Disease) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07106814 Safety and Efficacy of Metabolically Armed Tumor-lnfiltrating Lymphocytes (Meta10-TIL) for the Treatment of Advanced Solid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06287034 The Role of the Free/Pedunculated Flap in Total Laryngectomy After (Chemo-)Radiotherapy Failure for Laryngeal Carcinoma: Impact on the Risk of Pharyngocutaneous Fistula (PCF) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05544084 Adaptation and Implementation of a Patient Navigation Program for Cervical Cancer Screening Across Contexts in Senegal No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03968406 Talazoparib and Radiation Therapy in Treating Patients With Locally Recurrent Gynecologic Cancers No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT02838836 Tumor Cell and DNA Detection in the Blood, Urine and Bone Marrow of Patients With Solid Cancers No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06529809 Accelerated Brachytherapy Forward Chemo Radiation Therapy (ABC-RT) for Locally-advanced Cervical 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-VAR-CERVICAL-FRAIL-V1 | version: 1 | generated: 2026-06-27T09:41:01.193542+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.