OpenOnco · Treatment Plan

Treatment plan — Medullary thyroid carcinoma

PLAN-AUTO-MTC-001-V1 · v1 · 2026-07-26

Patient

AUTO-MTC-001 · Algorithm: ALGO-MTC-1L

DiagnosisMedullary thyroid carcinoma

MOH / ICD-10C73

ICD-O-38345/3; C73

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-RET	BIO definition in KB; no ESCAT BMA entry — verify with clinician

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-MTC-ADVANCED-1L-SELPERCATINIB

Regimen

Selpercatinib monotherapy (advanced/progressive RET-mutant MTC, 1L)

Drugs + NSZU

Selpercatinib (DRUG-SELPERCATINIB) 160 mg PO BID with food (≥50 kg); 120 mg BID (<50 kg) · Continuous, until progression or unacceptable toxicity · PO ✗ Not registered in UA

Reason

Primary current-line option per algorithm ALGO-MTC-1L: selected default was filtered; promoted first remaining current-line track

What NOT to do

Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity

Standard plan (IND-MTC-ADVANCED-1L-SELPERCATINIB)

Do NOT start systemic therapy in asymptomatic, structurally stable, slowly-rising-calcitonin MTC — observe with calcitonin / CEA q3-6 mo + imaging q6-12 mo.
Do NOT use radioactive iodine (RAI) in MTC — parafollicular C-cells do not concentrate iodide; RAI has zero efficacy.
Do NOT skip germline RET testing — ~25% of MTC is hereditary; positive germline drives kindred screening + pheochromocytoma surveillance + prophylactic-thyroidectomy timing in offspring.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Selpercatinib monotherapy (advanced/progressive RET-mutant MTC, 1L)

28-day cycles × Continuous until progression

MDT brief

MDT talk tree (1 steps)

#	Owner	Topic	Action
1	molecular_geneticist	Specialist review	Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.

Skills (recommended) — for consideration (1)

Molecular geneticist / molecular oncologist recommended
Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.

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-MEN2-CONFIRMED-CARRIER, RF-MEN2-FAMILY-HISTORY-SUSPICION, RF-MTC-FRAILTY-AGE, RF-MTC-HIGH-RISK-BIOLOGY, RF-MTC-INFECTION-SCREENING, RF-MTC-ORGAN-DYSFUNCTION, RF-MTC-RET-MUTANT, RF-MTC-TRANSFORMATION-PROGRESSION

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-NCCN-THYROID-2025: NCCN Clinical Practice Guidelines — Thyroid Carcinoma (2025.v2)
SRC-ONCOKB: OncoKB — Precision Oncology Knowledge Base (continuous (last verified 2026-04-25))

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: 2026-07-26.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT06161532	Sacituzumab Govitecan With or Without Atezolizumab Immunotherapy in Rare Genitourinary Tumors (SMART) Such as High Grade Neuroendocrine Carcinomas, Adenocarcinoma, and Squamous Cell Bladder/Urinary Tract Cancer, Renal Medullary Carcinoma and Penile C...	PHASE2	RECRUITING	National Cancer Institute (NCI)	—	Surrogate endpoint only Single country
NCT06277180	68Ga-TCR-FAPI PET/CT Guided Precision Surgery for MTC	NA	RECRUITING	Cancer Institute and Hospital, Chinese Academy of Medical Sciences	—	Single country
NCT04216732	Natural History of Medullary Thyroid Cancer to Inform Advanced Disease Management	N/A	RECRUITING	M.D. Anderson Cancer Center	—	Single country
NCT06141369	Treatment of Advanced Endocrine Tumor With Iindividualized mRNA Neoantigen Vaccine (mRNA-0523-L001)	NA	RECRUITING	Shanghai Jiao Tong University School of Medicine	—	Small N (<50) Single country
NCT01109420	Clinical and Genetic Studies in Familial Non-medullary Thyroid Cancer	N/A	RECRUITING	National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)	—	Single country
NCT03866382	Testing the Effectiveness of Two Immunotherapy Drugs (Nivolumab and Ipilimumab) With One Anti-cancer Targeted Drug (Cabozantinib) for Rare Genitourinary Tumors	PHASE2	RECRUITING	National Cancer Institute (NCI)	—	Surrogate endpoint only
NCT03892993	Patient Decision Aid in Supporting Decision-Making About When to Start or Stop New Drugs, Join Clinical Trials, or Continue Active Surveillance in Patients With Medullary Thyroid Cancer and Their Caregivers	NA	RECRUITING	M.D. Anderson Cancer Center	—	Single country
NCT07016230	Study Investigating Tarlatamab (AMG 757) in Patients With Metastatic/Locally Advanced Small-Cell Lung Cancer (SCLC) and Other Poorly Differentiated Neuroendocrine Carcinomas (NECs), With Biomarker Analysis to Characterize Response/Resistance (UNLOCK TARLATAMAB)	PHASE2	RECRUITING	Gustave Roussy, Cancer Campus, Grand Paris	—	Small N (<50) Surrogate endpoint only Single country
NCT03765333	GETNE Registration of Thyroid Cancer	N/A	RECRUITING	Grupo Espanol de Tumores Neuroendocrinos	—	Small N (<50) Single country
NCT06523582	Genetic Bases of Neuroendocrine Neoplasms in Mexican Patients	N/A	RECRUITING	Universidad Nacional Autonoma de Mexico	—	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 Selpercatinib monotherapy (advanced/progressive RET-mutant MTC, 1L) (REG-SELPERCATINIB-MTC-1L) 1/1 component drug(s) not registered in Ukraine +1	✗ not registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Trial · NCT06161532 Sacituzumab Govitecan With or Without Atezolizumab Immunotherapy in Rare Genitourinary Tumors (SMART) Such as High Grade Neuroendocrine Carcinomas, Adenocarcinoma, and Squamous Cell Bladder/Urinary Tract Cancer, Renal Medullary Carcinoma and Penile C... No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06277180 68Ga-TCR-FAPI PET/CT Guided Precision Surgery for MTC No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04216732 Natural History of Medullary Thyroid Cancer to Inform Advanced Disease Management No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06141369 Treatment of Advanced Endocrine Tumor With Iindividualized mRNA Neoantigen Vaccine (mRNA-0523-L001) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT01109420 Clinical and Genetic Studies in Familial Non-medullary Thyroid Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03866382 Testing the Effectiveness of Two Immunotherapy Drugs (Nivolumab and Ipilimumab) With One Anti-cancer Targeted Drug (Cabozantinib) for Rare Genitourinary Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03892993 Patient Decision Aid in Supporting Decision-Making About When to Start or Stop New Drugs, Join Clinical Trials, or Continue Active Surveillance in Patients With Medullary Thyroid Cancer and Their Caregivers No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07016230 Study Investigating Tarlatamab (AMG 757) in Patients With Metastatic/Locally Advanced Small-Cell Lung Cancer (SCLC) and Other Poorly Differentiated Neuroendocrine Carcinomas (NECs), With Biomarker Analysis to Characterize Response/Resistance (UNLOCK TARLATAMAB) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03765333 GETNE Registration of Thyroid Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06523582 Genetic Bases of Neuroendocrine Neoplasms in Mexican Patients 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: 2026-07-26.

plan_id: PLAN-AUTO-MTC-001-V1 | version: 1 | generated: 2026-07-26T09:28:48.509562+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.