OpenOnco · Treatment Plan

Treatment plan — DIS-OVARIAN

PLAN-BMA-BARD1_GERMLINE_OVARIAN-V1 · v1 · 2026-05-04

Patient

BMA-BARD1_GERMLINE_OVARIAN · Algorithm: ALGO-OVARIAN-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
BIO-HRR-PANEL	BARD1 germline pathogenic	IIB	SRC-CIVIC: Level A (Supports, Sensitivity/Response)	BARD1 germline pathogenic in EOC: rare; included in HRR panels; PARPi benefit extrapolated from HRD-positive trial subgroups (PAOLA-1, NOVA non-gBRCA). ESCAT IIB / OncoKB Level 3B.	niraparib maintenance olaparib + bevacizumab (HRD-positive)	SRC-NCCN-OVARIAN-2025 SRC-ESMO-OVARIAN-2024
BIO-HRR-PANEL	BRIP1 germline pathogenic	IIA	SRC-CIVIC: Level A (Supports, Sensitivity/Response)	BRIP1 (FANCJ) germline pathogenic in EOC: established moderate-risk gene (~RR 3-5); included in HRR panels and HRD-positive PARPi trial subgroups. NCCN includes BRIP1 in PARPi-eligible HRR list. ESCAT IIA / OncoKB Level 3A.	niraparib maintenance olaparib + bevacizumab (HRD-positive) rucaparib (LOH-high)	SRC-NCCN-OVARIAN-2025 SRC-ESMO-OVARIAN-2024
BIO-HRR-PANEL	FANCA germline pathogenic (heterozygous)	IIIA	SRC-NCCN-OVARIAN-2025 SRC-ESMO-OVARIAN-2024 Evidence cited from clinical guidelines; per-source evidence levels not yet structured. See Phase-2-of-CIViC-pivot for re-cite roadmap.	FANCA germline (heterozygous) in EOC: Fanconi-anemia-pathway gene; biallelic loss = Fanconi anemia (recessive). Heterozygous carriers have uncertain cancer risk. FANCA included in some HRR panels (FANCL on PROfound HRR list). PARPi off-label consideration in HRD-positive. ESCAT IIIA / OncoKB Level 3B.	niraparib (HRD-positive) olaparib + bevacizumab	SRC-NCCN-OVARIAN-2025 SRC-ESMO-OVARIAN-2024
BIO-HRR-PANEL	FANCL germline pathogenic (heterozygous)	IIIA	SRC-NCCN-OVARIAN-2025 SRC-ESMO-OVARIAN-2024 Evidence cited from clinical guidelines; per-source evidence levels not yet structured. See Phase-2-of-CIViC-pivot for re-cite roadmap.	FANCL germline (heterozygous) in EOC: Fanconi-anemia-pathway gene; biallelic loss = Fanconi anemia (recessive). Heterozygous carriers have uncertain cancer risk. FANCL included in some HRR panels (FANCL on PROfound HRR list). PARPi off-label consideration in HRD-positive. ESCAT IIIA / OncoKB Level 3B.	niraparib (HRD-positive) olaparib + bevacizumab	SRC-NCCN-OVARIAN-2025 SRC-ESMO-OVARIAN-2024
BIO-HRR-PANEL	PALB2 germline pathogenic	IIA	SRC-CIVIC: Level A (Supports, Sensitivity/Response)	PALB2 germline pathogenic in EOC: rare (~1%); biologically HR-deficient. Niraparib NOVA non-gBRCA cohort and rucaparib ARIEL3 LOH-high included PALB2; olaparib + bev (PAOLA-1) in HRD-positive includes PALB2. ESCAT IIA / OncoKB Level 3A.	niraparib maintenance olaparib + bevacizumab (HRD-positive) rucaparib maintenance	SRC-NCCN-OVARIAN-2025 SRC-ESMO-OVARIAN-2024
BIO-HRR-PANEL	RAD51B germline pathogenic	IIB	SRC-CIVIC: Level A (Supports, Sensitivity/Response)	RAD51B germline pathogenic in EOC: confers HR deficiency. RAD51C and RAD51D have established EOC risk; included in HRR panels and HRD-positive PARPi trial subgroups (PAOLA-1, ARIEL3 LOH-high, NOVA non-gBRCA). RAD51B less established. ESCAT IIA-IIB / OncoKB 3A-3B.	niraparib maintenance olaparib + bevacizumab (HRD-positive) rucaparib maintenance	SRC-NCCN-OVARIAN-2025 SRC-ESMO-OVARIAN-2024
BIO-HRR-PANEL	RAD51C germline pathogenic	IIA	SRC-NCCN-OVARIAN-2025 SRC-ESMO-OVARIAN-2024 Evidence cited from clinical guidelines; per-source evidence levels not yet structured. See Phase-2-of-CIViC-pivot for re-cite roadmap.	RAD51C germline pathogenic in EOC: confers HR deficiency. RAD51C and RAD51D have established EOC risk; included in HRR panels and HRD-positive PARPi trial subgroups (PAOLA-1, ARIEL3 LOH-high, NOVA non-gBRCA). RAD51B less established. ESCAT IIA-IIB / OncoKB 3A-3B.	niraparib maintenance olaparib + bevacizumab (HRD-positive) rucaparib maintenance	SRC-NCCN-OVARIAN-2025 SRC-ESMO-OVARIAN-2024
BIO-HRR-PANEL	RAD51D germline pathogenic	IIA	SRC-CIVIC: Level A (Supports, Sensitivity/Response)	RAD51D germline pathogenic in EOC: confers HR deficiency. RAD51C and RAD51D have established EOC risk; included in HRR panels and HRD-positive PARPi trial subgroups (PAOLA-1, ARIEL3 LOH-high, NOVA non-gBRCA). RAD51B less established. ESCAT IIA-IIB / OncoKB 3A-3B.	niraparib maintenance olaparib + bevacizumab (HRD-positive) rucaparib maintenance	SRC-NCCN-OVARIAN-2025 SRC-ESMO-OVARIAN-2024
BIO-HRR-PANEL	RAD54L germline pathogenic	IIIA	SRC-CIVIC: Level A (Supports, Sensitivity/Response)	RAD54L germline variants: rare; HR-pathway gene with limited clinical evidence. Included in some HRR panels but no labeled indication. ESCAT IIIA / OncoKB Level 4.	standard therapy PARPi off-label (HRD context only)	SRC-NCCN-OVARIAN-2025 SRC-ESMO-OVARIAN-2024

Treatment options (3 tracks)

Standard plan

★ DEFAULT

Indication

IND-OVARIAN-ADVANCED-1L-CARBO-PACLI-HRD-NEG

Regimen

Carboplatin + Paclitaxel (ovarian 3-weekly)

Drugs + NSZU

Carboplatin (DRUG-CARBOPLATIN) AUC 5-6 · IV day 1 every 21d · IV ✓ NSZU covered
Paclitaxel (DRUG-PACLITAXEL) 175 mg/m² · IV day 1 every 21d · IV ✓ NSZU covered

Reason

Engine default per algorithm ALGO-OVARIAN-ADVANCED-1L: {'step': 6, 'outcome': False, 'branch': {'result': 'IND-OVARIAN-ADVANCED-1L-CARBO-PACLI-HRD-NEG'}, 'fired_red_flags': [], 'winner_red_flag': None}

Aggressive plan

Indication

IND-OVARIAN-ADVANCED-1L-CARBO-PACLI-HRD-OLAP

Regimen

Carboplatin + Paclitaxel (ovarian 3-weekly)

Drugs + NSZU

Carboplatin (DRUG-CARBOPLATIN) AUC 5-6 · IV day 1 every 21d · IV ✓ NSZU covered
Paclitaxel (DRUG-PACLITAXEL) 175 mg/m² · IV day 1 every 21d · IV ✓ NSZU covered

Reason

Alternative track presented for HCP consideration

Aggressive plan

Indication

IND-OVARIAN-MAINTENANCE-OLAPARIB

Regimen

Olaparib maintenance (HRD+ ovarian post-platinum response)

Drugs + NSZU

Olaparib (DRUG-OLAPARIB) 300 mg PO BID continuous · Continuous · PO ✓ NSZU covered

Reason

Alternative track presented for HCP consideration

Pre-treatment investigations

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

ID	Name	Priority	Category	Where to order	Needed for
TEST-CBC	Complete Blood Count with Differential	Critical	lab	—	aggressive

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

BRCA1 or BRCA2 pathogenic variant (germline OR somatic) in high-grade serous ovarian carcinoma — ~20-25% prevalence (15% germline + ~7% somatic). Olaparib maintenance after platinum-based 1L (SOLO-1 — mPFS 56.0 vs 13.8 mo BRCA-mut) is treatment-defining; rucaparib + niraparib alternatives. SOLO-2 — 2L+ relapse maintenance. RF-OVARIAN-BRCA-MUT-ACTIONABLE
Frailty profile precluding standard carbo+pacli + bev intensified induction in ovarian: ECOG ≥3, OR (age ≥75 + Charlson ≥3), OR composite (age ≥70 + ascites large-volume + albumin <3.0). Triggers carbo-mono OR weekly-dose-dense-pacli (less neuropathy / bone marrow). RF-OVARIAN-FRAILTY-AGE
HRD-positive (BRCA1/2 mutation OR Genomic Instability Score ≥42) high-grade serous ovarian carcinoma. Treatment-defining for PARPi maintenance after platinum-based induction. Olaparib (SOLO-1 BRCA-only, PAOLA-1 with bev) + niraparib (PRIMA all-comer) substantially improve PFS in HRD-positive subset. RF-OVARIAN-HRD-ACTIONABILITY
Homologous Recombination Deficiency (HRD)-positive high-grade serous ovarian carcinoma (BRCA1/2 mutation OR Genomic Instability Score ≥42). PARPi maintenance after platinum-based induction is treatment-defining: niraparib (PRIMA — mPFS 21.9 vs 10.4 mo HRD-pos), olaparib + bevacizumab (PAOLA-1 — mPFS 37.2 vs 17.7 mo HRD-pos). RF-OVARIAN-HRD-POSITIVE-ACTIONABLE
Suboptimal primary cytoreductive surgery (residual disease ≥1 cm) or unresectable at presentation in advanced (FIGO III-IV) ovarian carcinoma. MDT-trigger for neoadjuvant chemo (NACT) → interval debulking surgery (IDS) pathway per CHORUS / EORTC55971 trials, rather than primary debulking. RF-OVARIAN-SUBOPTIMAL-DEBULKING

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-OVARIAN-ADVANCED-1L-CARBO-PACLI-HRD-NEG)

Do NOT use olaparib maintenance in HRD-negative — minimal benefit, MDS/AML risk
Do NOT initiate bev maintenance within 28 days of major surgery

Aggressive plan (IND-OVARIAN-ADVANCED-1L-CARBO-PACLI-HRD-OLAP)

Do NOT skip HRD testing — defines maintenance choice (PARPi-only HRD+; niraparib-all-comer if HRD-negative weak benefit)
Do NOT start olaparib without confirmed CR/PR to platinum induction
Do NOT continue olaparib through Grade 3 anemia without dose reduction

Aggressive plan (IND-OVARIAN-MAINTENANCE-OLAPARIB)

Do NOT start without confirmed CR/PR to platinum
Do NOT continue past 2 years for non-BRCA HRD+ unless still benefiting (label allows ≤24 mo)
Do NOT skip pre-treatment counseling on long-term MDS/AML risk

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Carboplatin + Paclitaxel (ovar

21-day cycles × 6 cycles (per GOG-218 / ICON-7 induction); subsequent maintenance per HRD/biomarker stratification

MDT brief

Skills (recommended) — for consideration (2)

Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
skill: clinical_pharmacistv0.1.0reviewed 2026-04-25STUBsign-offs: 0lead: TBD
Molecular geneticist / molecular oncologist recommended
Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.
skill: molecular_geneticistv0.1.0reviewed 2026-04-25STUBsign-offs: 0lead: TBD

Open questions (1, 0 blocking)

OQ-LDH-CURRENT
What is the current LDH? Marker of tumor burden and transformation.
LDH is part of the prognostic indices of indolent lymphomas.
→ hematologist

Data quality

Unevaluated RedFlags: RF-BREAST-OVARIAN-HRD-ASSAY-DISTINCTION, RF-OVARIAN-BRCA-MUT-ACTIONABLE, RF-OVARIAN-FRA-HIGH-ACTIONABLE, RF-OVARIAN-FRAILTY-AGE, RF-OVARIAN-HRD-ACTIONABILITY, RF-OVARIAN-HRD-POSITIVE-ACTIONABLE, RF-OVARIAN-INFECTION-SCREENING, RF-OVARIAN-PERIOPERATIVE-VTE, RF-OVARIAN-PLATINUM-RESISTANT, RF-OVARIAN-PLATINUM-SENSITIVE, RF-OVARIAN-SUBOPTIMAL-DEBULKING, RF-OVARIAN-TRANSFORMATION-PROGRESSION, RF-PAN-BRCA-SOMATIC-PARPI-CANDIDATE

Skill catalog (2/16 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-OVARIAN-2024: ESMO Ovarian Cancer Clinical Practice Guideline (2024)
SRC-NCCN-OVARIAN-2025: NCCN Ovarian 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: 2026-05-04.

NCT	Title	Phase	Status	Sponsor	UA
NCT07186842	A Clinical Trial to Test if the Investigational Drug BNT329 is Safe and Potentially Beneficial for People With Advanced Solid Tumors Known to Express the Tumor Marker CA19-9	PHASE1 / PHASE2	RECRUITING	BioNTech SE	—
NCT07524322	Study of RGT-490 in Patients With PIK3CA-Mutated Advanced Solid Tumors	PHASE1	RECRUITING	Regor Pharmaceuticals Inc.	—
NCT02253251	Clinical Validation of the Role of microRNA Binding Site Mutations in Cancer Risk, Prevention and Treatment	N/A	RECRUITING	MiraKind	—
NCT07229313	A Study of KIVU-107 in Participants With Locally Advanced or Metastatic Solid Tumors	PHASE1	RECRUITING	Kivu Bioscience Inc.	—
NCT02869568	Institut Paoli Calmettes Ovarian Cancer Database	N/A	RECRUITING	Institut Paoli-Calmettes	—
NCT06234423	A Study of CUSP06 in Patients With Platinum-Refractory/Resistant Ovarian Cancer and Other Advanced Solid Tumors	PHASE1	RECRUITING	OnCusp Therapeutics, Inc.	—
NCT07523529	Biomarker-Guided Dual-Target CAR-T Cells for Advanced Solid Tumors	PHASE1 / PHASE2	RECRUITING	Beijing Biotech	—
NCT04575935	Minimally Invasive Surgery After Neoadjuvant Chemotherapy for the Treatment of Stage IIIC-IV Ovarian, Primary Peritoneal, or Fallopian Tube Cancer, LANCE Trial	PHASE3	RECRUITING	M.D. Anderson Cancer Center	—
NCT04921527	Chiauranib Plus Weekly Paclitaxel in Patients with Platinum-refractory or Platinum-resistant Recurrent Ovarian Cancer	PHASE3	RECRUITING	Chipscreen Biosciences, Ltd.	—
NCT04329494	PIPAC for the Treatment of Peritoneal Carcinomatosis in Patients With Ovarian, Uterine, Appendiceal, Colorectal, or Gastric Cancer	PHASE1	RECRUITING	City of Hope Medical Center	—

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 Carboplatin + Paclitaxel (ovarian 3-weekly) (REG-CARBO-PACLI-OVARIAN)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Aggressive plan Carboplatin + Paclitaxel (ovarian 3-weekly) (REG-CARBO-PACLI-OVARIAN)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Aggressive plan Olaparib maintenance (HRD+ ovarian post-platinum response) (REG-OLAPARIB-MAINT-OVARIAN)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT07186842 A Clinical Trial to Test if the Investigational Drug BNT329 is Safe and Potentially Beneficial for People With Advanced Solid Tumors Known to Express the Tumor Marker CA19-9 No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07524322 Study of RGT-490 in Patients With PIK3CA-Mutated Advanced Solid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT02253251 Clinical Validation of the Role of microRNA Binding Site Mutations in Cancer Risk, Prevention and Treatment No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07229313 A Study of KIVU-107 in Participants With Locally Advanced or Metastatic Solid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT02869568 Institut Paoli Calmettes Ovarian Cancer Database No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06234423 A Study of CUSP06 in Patients With Platinum-Refractory/Resistant Ovarian Cancer and Other Advanced Solid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07523529 Biomarker-Guided Dual-Target CAR-T Cells for Advanced Solid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04575935 Minimally Invasive Surgery After Neoadjuvant Chemotherapy for the Treatment of Stage IIIC-IV Ovarian, Primary Peritoneal, or Fallopian Tube Cancer, LANCE Trial No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04921527 Chiauranib Plus Weekly Paclitaxel in Patients with Platinum-refractory or Platinum-resistant Recurrent Ovarian Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04329494 PIPAC for the Treatment of Peritoneal Carcinomatosis in Patients With Ovarian, Uterine, Appendiceal, Colorectal, or Gastric 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: 2026-05-04.

plan_id: PLAN-BMA-BARD1_GERMLINE_OVARIAN-V1 | version: 1 | generated: 2026-05-04T14:13:16.571338+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.