Patient
AUTO-GI-NET-001 · Algorithm: ALGO-GI-NET-ADVANCED-1L
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 |
|---|
| No clinically actionable variants matched in this profile. |
| Biomarker | Status |
|---|
| BIO-KI67-PROLIFERATION | Not in KB — ask clinician to verify |
Primary current-line option
- Indication
- IND-GI-NET-ADVANCED-1L-LANREOTIDE
- Regimen
- Lanreotide Autogel 120 mg SC q4w (well-differentiated GEP-NET G1/G2; CLARINET)
- Drugs + NSZU
- Lanreotide (DRUG-LANREOTIDE) 120 mg SC deep subcutaneous injection · Every 4 weeks (q4w). Administer into lateral upper outer quadrant of buttock. Alternate sides. Patient/caregiver can self-inject after training. · SC ⚠ Out-of-pocket
- Reason
- Primary current-line option selected by ALGO-GI-NET-ADVANCED-1L at step 3; branch-driving red flag: RF-FITNESS-ECOG-FIT.
Why this branch was chosen
Triggers from the patient profile that fired and drove the chosen branch.
Step 3 → branch IND-GI-NET-ADVANCED-1L-LANREOTIDE
- RF-FITNESS-ECOG-FIT ★ winner: —
Red flags — PRO / CONTRA aggressive
PRO-AGGRESSIVE
Triggers that push toward the aggressive track
- Poor performance status (ECOG ≥3): patient capable of only limited self-care, confined to bed/chair >50% of waking hours, or completely disabled. Generally palliative/best-supportive-care intent; cytotoxic therapy at full dose contraindicated. Selective targeted-therapy or steroid debulk may be appropriate as bridge to reassessment.
RF-FITNESS-ECOG-POOR
- Well-differentiated or poorly-differentiated neuroendocrine tumor with Ki67 >20% (WHO 2019 G3). High-grade disease is clinically and therapeutically distinct from G1/G2: well-differentiated G3 pNET may still respond to everolimus/sunitinib/SSA but outcomes are inferior; poorly differentiated neuroendocrine carcinoma (NEC, Ki67 typically >55%) requires platinum- etoposide chemotherapy (CAPEOX/EP/IP). Engine flag routes to MDT review.
RF-NET-HIGH-GRADE-G3
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-GI-NET-ADVANCED-1L-LANREOTIDE)
- Не призначати SSA-монотерапію при погано-диференційоваnoй NEC (Ki67 >55%) — протипоказано для антипроліферативного застосування
- Не пропускати DOTATATE PET/CT — підтверджує SSTR2+ status; від'ємний scan означає низьку ймовірnoсть відповіді на SSA
- Не забувати IV октреотид перед хірургічним втручанням або емболізацією — ризик карциноїдного кризу
- Не ігнорувати ехокардіографію при кліnoчному карциноїдному синдромі — хвороба серця у ~20%
Timeline
Treatment timeline — derived from regimen + monitoring schedule
Standard plan
Induction · Lanreotide Autogel 120 mg SC q4w (well-differentiated GEP-NET G1/G2; CLARINET)
28-day cycles × Continuous until progression or unacceptable toxicity
MDT brief
MDT talk tree (1 steps)
| # | Owner | Topic | Action |
|---|
| 1 | social_worker_case_manager | Specialist review | Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed. |
Skills (recommended) — for consideration (1)
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: 1/1 known (100%), 0 missing, 0 default-track gaps
- Unevaluated RedFlags: RF-NET-CARCINOID-SYNDROME, RF-NET-HIGH-GRADE-G3
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 | Sign-offs | Domain |
|---|
| Cellular therapy specialist (CAR-T) | cellular_therapy_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
| Clinical pharmacist | clinical_pharmacist | v0.1.0 | 2026-04-25 | 0 | clinical_pharmacy |
| Hematologist / oncohematologist | hematologist | v0.1.0 | 2026-04-25 | 0 | hematology_oncology |
| Hematopathologist (lymphoma / leukemia / myeloma) | hematopathologist | v0.1.0 | 2026-04-25 | 0 | hematopathology |
| Infectious disease / hepatology | infectious_disease_hepatology | v0.1.0 | 2026-04-25 | 0 | infectious_diseases |
| Medical oncologist (solid-tumor chemotherapist) | medical_oncologist | v0.1.0 | 2026-04-25 | 0 | solid_oncology |
| Molecular geneticist / molecular oncologist | molecular_geneticist | v0.1.0 | 2026-04-25 | 0 | molecular_oncology |
| Palliative care | palliative_care | v0.1.0 | 2026-04-25 | 0 | palliative_care |
| Pathologist (general) | pathologist | v0.1.0 | 2026-04-25 | 0 | pathology |
| Primary care / family physician | primary_care | v0.1.0 | 2026-04-25 | 0 | primary_care |
| Psycho-oncologist | psychologist | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Radiation oncologist | radiation_oncologist | v0.1.0 | 2026-04-25 | 0 | radiation_oncology |
| Radiologist | radiologist | v0.1.0 | 2026-04-25 | 0 | diagnostic_imaging |
| Social worker / case manager | social_worker_case_manager | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Surgical oncologist | surgical_oncologist | v0.1.0 | 2026-04-25 | 0 | surgical_oncology |
| Transplant specialist (BMT) | transplant_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
Sources cited
- SRC-CLARINET-CAPLIN-2014: Lanreotide in Metastatic Enteropancreatic Neuroendocrine Tumors (CLARINET; phase III)
(None)
- SRC-NCCN-NET-2025: NCCN Neuroendocrine and Adrenal Tumors (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: 2026-05-13.
| NCT | Title | Phase | Status | Sponsor | UA | Signals | Eligibility (excerpt) |
|---|
| NCT04907643 | Virtual Reality for GI Cancer Pain to Improve Patient Reported Outcomes | NA | RECRUITING | — | 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 Lanreotide Autogel 120 mg SC q4w (well-differentiated GEP-NET G1/G2; CLARINET) (REG-LANREOTIDE-AUTOGEL-GI-NET) 1/1 component drug(s) not on NSZU formulary | ✓ registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
| Trial · NCT04907643 Virtual Reality for GI Cancer Pain to Improve Patient Reported Outcomes 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.