Clinical significance of mutations (ESCAT)

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

Biomarker	Variant	ESCAT	Evidence	Clinical significance	Drugs	Sources
BIO-PDL1-CPS	(gene-level)	IA	SRC-NCCN-ESOPHAGEAL-2025 SRC-ESMO-ESOPHAGEAL-2024 Evidence cited from clinical guidelines; per-source evidence levels not yet structured. See Phase-2-of-CIViC-pivot for re-cite roadmap.	PD-L1 CPS used as eligibility threshold for ICI in metastatic esophageal cancer. Esophageal SCC: CPS ≥10 — pembrolizumab + cisplatin + fluoropyrimidine 1L (KEYNOTE-590), and pembrolizumab monotherapy 2L (KEYNOTE-181 CPS≥10 subgroup). Esophageal adeno and GEJ: same CPS criteria as gastric adeno (NCCN 2025 treats GEJ adeno with gastric algorithm). Testing by IHC 22C3 pharmDx mandatory. Threshold-gated indication selection is performed by the algorithm layer (IND-ESOPH-METASTATIC-2L-PEMBRO-CPS10); this BMA entry surfaces ESCAT tier context only.	pembrolizumab + cisplatin + fluoropyrimidine (CPS≥10 SCC 1L per SRC-NCCN-ESOPHAGEAL-2025) pembrolizumab monotherapy (CPS≥10 SCC/adeno 2L per SRC-NCCN-ESOPHAGEAL-2025)	SRC-NCCN-ESOPHAGEAL-2025 SRC-ESMO-ESOPHAGEAL-2024

Primary current-line option

Standard plan

★ DEFAULT

Indication: IND-ESOPH-DEFINITIVE-CRT-SCC
Regimen: —
Reason: Primary current-line option selected by ALGO-ESOPH-DEFINITIVE-1L at step 1.

Pre-treatment investigations

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

ID	Name	Priority	Category	Where to order	Needed for
TEST-CT-CHEST-ABDOMEN-PELVIS	CT chest + abdomen + pelvis with IV contrast	Critical	imaging	—	all tracks
TEST-CT-PET	PET-CT with FDG	Desired	imaging	—	all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Severe dysphagia with weight loss / aspiration risk in esophageal cancer: inability to swallow saliva, recurrent aspiration pneumonia, >10% weight loss in 3 months, OR malignant tracheoesophageal fistula. Mandates urgent palliative intervention (stenting OR dilation OR diversion) BEFORE any definitive systemic / RT therapy. RF-ESOPH-SEVERE-DYSPHAGIA-ASPIRATION

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-ESOPH-DEFINITIVE-CRT-SCC)

Do NOT escalate RT dose beyond 50.4 Gy — INT-0123 / RTOG 94-05 showed no OS benefit and increased toxicity at 64.8 Gy
Do NOT proceed with definitive CRT without addressing severe dysphagia / aspiration risk first (NG/PEG planning if needed)
Do NOT omit nutritional + esophagitis supportive care — CRT esophagitis peaks weeks 3-5 and limits hydration / oral intake
Do NOT switch to surgery-then-adjuvant pattern in a T4b unresectable patient — definitive CRT is the standard, not a bridge

MDT brief

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-ESOPH-FRAILTY-AGE, RF-ESOPH-HIGH-RISK-BIOLOGY, RF-ESOPH-INFECTION-SCREENING, RF-ESOPH-SEVERE-DYSPHAGIA-ASPIRATION, RF-ESOPH-TRANSFORMATION-PROGRESSION, RF-ESOPHAGEAL-POST-CROSS-NON-PCR, RF-OLIGOMET-DEFINITION

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).

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-ESOPHAGEAL-2024: ESMO Esophageal Cancer (2024)
SRC-NCCN-ESOPHAGEAL-2025: NCCN Esophageal and EGJ Cancers (v.3.2025)
SRC-RTOG-8501-HERSKOVIC-1992: Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus (1992)

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: 2026-05-13.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT06787313	Precision Palliative Care for Patients With Advanced Esophageal Cancer	N/A	RECRUITING	Fudan University	—	Single country
NCT05473156	A Study to Investigate the Safety, Pharmacokinetics, and Clinical Activity of AP203 in Patients with Locally Advanced or Metastatic Solid Tumors, and Expansion to Selected Malignancies	PHASE1 / PHASE2	RECRUITING	AP Biosciences Inc.	—	Surrogate endpoint only Single country
NCT06790797	Investigating the Biomarkers in Tumor and Peripheral Blood to Evaluate the Efficacy of Cancer Immunotherapy in Chest Cancer Patients	N/A	RECRUITING	Zhao Jun	—	Single country
NCT07070466	Ivonescimab in Comb. With FOLFOX in Advanced HER2 Neg. GEA	PHASE2	RECRUITING	Massachusetts General Hospital	—	Small N (<50) Surrogate endpoint only Single country
NCT05875870	Effects of Bright-light Exposure Combined With Specific Exercise Training (BEST) Program in Patients With Cancer	NA	RECRUITING	Taipei Veterans General Hospital, Taiwan	—	Single country
NCT06535607	Study of Volrustomig as Monotherapy or in Combination With Anti- Cancer Agents in Participants With Advanced/Metastatic Solid Tumors	PHASE2	RECRUITING	AstraZeneca	—	Surrogate endpoint only
NCT03222895	Distribution of Lymph Node Metastases in Esophageal Carcinoma	N/A	RECRUITING	Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)	—	—
NCT06339619	Combination Immunotherapy of Adebrelimab With Apatinib and Tegafur for Immune Rechallenge Therapy in Esophageal Squamous Cell Carcinoma	PHASE2	RECRUITING	Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University	—	Small N (<50) Surrogate endpoint only Single country
NCT05775939	PET/CT Imaging to Evaluate Cardiac Radiation Damage in Patients With Lung or Esophageal Cancer, EUCLID Trial	NA	RECRUITING	Thomas Jefferson University	—	Small N (<50) Single country
NCT06077981	Comparison of 0.4% Hyaluronic Acid Solution Versus Hydroxyethylamide Solution in Submucosal Endoscopic Resections	NA	RECRUITING	Instituto do Cancer do Estado de São Paulo	—	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 — No regimen components on this track — availability unknown	— unknown	— unknown	₴-? — verify pathway	not recorded
Trial · NCT06787313 Precision Palliative Care for Patients With Advanced Esophageal Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05473156 A Study to Investigate the Safety, Pharmacokinetics, and Clinical Activity of AP203 in Patients with Locally Advanced or Metastatic Solid Tumors, and Expansion to Selected Malignancies No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06790797 Investigating the Biomarkers in Tumor and Peripheral Blood to Evaluate the Efficacy of Cancer Immunotherapy in Chest Cancer Patients No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07070466 Ivonescimab in Comb. With FOLFOX in Advanced HER2 Neg. GEA No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05875870 Effects of Bright-light Exposure Combined With Specific Exercise Training (BEST) Program in Patients With Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06535607 Study of Volrustomig as Monotherapy or in Combination With Anti- Cancer Agents in Participants With Advanced/Metastatic Solid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03222895 Distribution of Lymph Node Metastases in Esophageal Carcinoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06339619 Combination Immunotherapy of Adebrelimab With Apatinib and Tegafur for Immune Rechallenge Therapy in Esophageal 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 · NCT06077981 Comparison of 0.4% Hyaluronic Acid Solution Versus Hydroxyethylamide Solution in Submucosal Endoscopic Resections 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: 2026-05-13.

plan_id: PLAN-VAR-ESOPHAGEAL-BIOMARK-V1 | version: 1 | generated: 2026-05-13T10:01:51.969895+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.