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: 2026-05-12.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT06669663	Hypoxia Driven Metabolic Response in Oesophagogastric Adenocarcinoma	N/A	RECRUITING	Imperial College London	—	Single country
NCT05624099	Camrelizumab Combined With Chemoradiotherapy in Advanced Esophageal Cancer.	PHASE2	RECRUITING	Fujian Cancer Hospital	—	Surrogate endpoint only Single country
NCT07554521	A Study to Evaluate Efficacy and Safety of Tislelizumab Plus Chemotherapy for Locally Advanced Unresectable or Metastatic Gastric or Gastroesophageal Adenocarcinoma and Esophageal Squamous Cell Carcinoma in Racial and Ethnic Minority Patients in the United States	PHASE2	RECRUITING	BeOne Medicines	—	Small N (<50) Single country
NCT03734952	Postoperative Radiotherapy in Thoracic Esophageal Squamous Cell Carcinoma With Neoadjuvant Chemoradiotherapy	NA	RECRUITING	Fujian Medical University Union Hospital	—	Single country
NCT05262491	A Study of BL-B01D1 in Patients With Locally Advanced or Metastatic Gastrointestinal Tumor and Other Solid Tumor	PHASE1	RECRUITING	Sichuan Baili Pharmaceutical Co., Ltd.	—	Phase 1 only Single country
NCT06747585	A Study to Investigate ALE.P02 as Monotherapy in Adult Patients With Selected CLDN1+ Solid Tumors	PHASE1 / PHASE2	RECRUITING	Alentis Therapeutics AG	—	Surrogate endpoint only
NCT03183115	RFA to Prevent Metachronous Squamous Neoplasia Recurrence After Complete Endoscopic Submucosal Dissection	NA	RECRUITING	E-DA Hospital	—	Single country
NCT05688176	Barrett's Esophagus and Esophageal Adenocarcinoma, Searching for Reliable Diagnostic RNA Plasma-based Biomarkers	N/A	RECRUITING	University Hospital, Ghent	—	Single country
NCT07224750	A Noninvasive and Screening miRNA Signature for Gastrointestinal Cancer	N/A	RECRUITING	City of Hope Medical Center	—	Single country
NCT06190782	Local Therapy for Oligometastatic ESCC Patients Treated With PD-1 Inhibitor	PHASE3	RECRUITING	Fudan University	—	Surrogate endpoint only 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 · NCT06669663 Hypoxia Driven Metabolic Response in Oesophagogastric Adenocarcinoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05624099 Camrelizumab Combined With Chemoradiotherapy in Advanced Esophageal Cancer. No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07554521 A Study to Evaluate Efficacy and Safety of Tislelizumab Plus Chemotherapy for Locally Advanced Unresectable or Metastatic Gastric or Gastroesophageal Adenocarcinoma and Esophageal Squamous Cell Carcinoma in Racial and Ethnic Minority Patients in the United States No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03734952 Postoperative Radiotherapy in Thoracic Esophageal Squamous Cell Carcinoma With Neoadjuvant Chemoradiotherapy No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05262491 A Study of BL-B01D1 in Patients With Locally Advanced or Metastatic Gastrointestinal Tumor and Other Solid Tumor No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06747585 A Study to Investigate ALE.P02 as Monotherapy in Adult Patients With Selected CLDN1+ Solid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03183115 RFA to Prevent Metachronous Squamous Neoplasia Recurrence After Complete Endoscopic Submucosal Dissection No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05688176 Barrett's Esophagus and Esophageal Adenocarcinoma, Searching for Reliable Diagnostic RNA Plasma-based Biomarkers No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07224750 A Noninvasive and Screening miRNA Signature for Gastrointestinal Cancer 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

Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-05-12.

plan_id: PLAN-VAR-ESOPHAGEAL-ORGAN-V1 | version: 1 | generated: 2026-05-12T18:41:26.378452+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.