Patient
BMA-FGFR2_MUTATION_ENDOMETRIAL · Algorithm: ALGO-ENDOMETRIAL-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-FGFR2 | activating mutation (~12% endometrioid; hotspots S252W, N549K, K310R) | IIA | - SRC-CIVIC: Level B (Supports, Sensitivity/Response)
- SRC-CIVIC: Level C (Supports, Sensitivity/Response)
- SRC-CIVIC: Level D (Supports, Sensitivity/Response)
| FGFR2 mutation in endometrial carcinoma (~10-12% endometrioid histology). Pemigatinib and erdafitinib have basket activity (FIGHT-207, Mirati / NCI-MATCH EAY131-W) — ORR ~25-30% in FGFR2-mutant endometrial. No regulatory approval for endometrial alone; tumor-agnostic FGFR-TKI label not yet granted. | pemigatinib (basket trial / NCI-MATCH for FGFR2-mutant endometrial)
erdafitinib (basket trial) | - SRC-NCCN-UTERINE-2025
- SRC-ESGO-ENDOMETRIAL-2025
|
Treatment options (2 tracks)
- Indication
- IND-ENDOMETRIAL-ADVANCED-1L-PEMBRO-CHEMO
- Regimen
- Pembrolizumab + carbo + paclitaxel (endometrial advanced 1L)
- Drugs + NSZU
- Pembrolizumab (DRUG-PEMBROLIZUMAB) 200 mg IV q3w · Continuous up to 2 years · IV ⚠ NSZU — not for this indication
- Carboplatin (DRUG-CARBOPLATIN) AUC 5 IV · Day 1 x 6 cycles · IV ⚠ NSZU — not for this indication
- Paclitaxel (DRUG-PACLITAXEL) 175 mg/m² IV · Day 1 x 6 cycles · IV ⚠ NSZU — not for this indication
- Reason
- Engine default per algorithm ALGO-ENDOMETRIAL-ADVANCED-1L: {'step': 1, 'outcome': False, 'branch': {'result': 'IND-ENDOMETRIAL-ADVANCED-1L-PEMBRO-CHEMO'}, 'fired_red_flags': [], 'winner_red_flag': None}
- Indication
- IND-ENDOMETRIAL-ADVANCED-1L-DOSTARLIMAB-CHEMO
- Regimen
- Dostarlimab + carbo + paclitaxel (endometrial advanced 1L dMMR)
- Drugs + NSZU
- Dostarlimab (DRUG-DOSTARLIMAB) 500 mg IV q3w → 1000 mg q6w maintenance · With chemo cycles 1-6 + maintenance up to 3 years · IV ✗ Not registered in UA
- Carboplatin (DRUG-CARBOPLATIN) AUC 5 IV · Day 1 x 6 cycles · IV ⚠ NSZU — not for this indication
- Paclitaxel (DRUG-PACLITAXEL) 175 mg/m² IV · Day 1 x 6 cycles · IV ⚠ NSZU — not for this indication
- 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-CECT-CAP | CECT chest/abdomen/pelvis | Critical | imaging | — | all tracks |
| TEST-ER-PR-IHC | ER + PR immunohistochemistry on tumor | Critical | — | CSD Lab ✓ (code TBC) | all tracks |
Timeline
Treatment timeline — derived from regimen + monitoring schedule
Standard plan
Induction · Pembrolizumab + carbo + paclit
21-day cycles × Chemo x 6; pembro maintenance up to 2 years
Aggressive plan
Induction · Dostarlimab + carbo + paclitax
21-day cycles × Chemo x 6; dostarlimab maintenance up to 3 years
MDT brief
Skills (recommended) — for consideration (1)
- Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
skill: clinical_pharmacistv0.1.0reviewed 2026-04-25STUBsign-offs: 0lead: TBD
Open questions (1, 0 blocking)
Data quality
- Unevaluated RedFlags: RF-ENDOMETRIAL-FIT-FOR-LENVATINIB-COMBO, RF-ENDOMETRIAL-FRAILTY-AGE, RF-ENDOMETRIAL-HIGH-RISK-BIOLOGY, RF-ENDOMETRIAL-INFECTION-SCREENING, RF-ENDOMETRIAL-ORGAN-DYSFUNCTION, RF-ENDOMETRIAL-TRANSFORMATION-PROGRESSION, RF-POLE-POLD1-ENDOMETRIAL-LOW-RISK
Skill catalog (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-ESMO-ENDOMETRIAL-2022: ESMO-ESGO-ESTRO Endometrial Consensus (2022)
- SRC-GY018-MAKKER-2022: (not in KB)
- SRC-NCCN-UTERINE-2025: NCCN Uterine Neoplasms (2025.v2)
- SRC-RUBY-MIRZA-2023: (not in KB)
Experimental options (clinical trials)
Last synced: 2026-05-04 · ctgov.
No active trials matched this scenario in ctgov.
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 Pembrolizumab + carbo + paclitaxel (endometrial advanced 1L) (REG-PEMBRO-CARBO-PACLI-ENDOM) | ✓ registered | ✓ covered | ₴-? — verify pathway | NSZU formulary |
| Aggressive plan Dostarlimab + carbo + paclitaxel (endometrial advanced 1L dMMR) (REG-DOSTARLIMAB-CARBO-PACLI-ENDOM) 1/3 component drug(s) not registered in Ukraine +1 | ✗ not registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-05-04.