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OpenOnco · DIS-GRANULOSA-CELL · BIO-FOXL2 (ESCAT IIB)
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Treatment plan — DIS-GRANULOSA-CELL
PLAN-BMA-FOXL2_GRANULOSA_CELL-V1 · v1 · 2026-05-04
Patient
BMA-FOXL2_GRANULOSA_CELL · Algorithm: ALGO-GRANULOSA-CELL-1L

Clinical significance of mutations (ESCAT)

Tumor-board context — the engine does not use these tiers to rank tracks
BiomarkerVariantESCATEvidenceClinical significanceDrugsSources
BIO-FOXL2FOXL2 p.C134W (c.402C>G) — present in ~97% of adult granulosa cell tumors; pathognomonic diagnostic marker; no FDA-approved targeted therapy as of 2026IIB
  • SRC-NCCN-OVARIAN-2025: Level Category 2A (Supports, Sensitivity/Response)
  • SRC-ESMO-OVARIAN-2024: Level B (Supports, Sensitivity/Response)
FOXL2 p.C134W (c.402C>G) is the defining molecular marker of adult granulosa cell tumor (AGCT), present in ~97% of cases and essentially absent in other ovarian tumors (100% positive predictive value when confirmed). The mutation distinguishes AGCT from: (1) Juvenile GCT (FOXL2 wild-type); (2) Other sex cord-stromal tumors (Sertoli-Leydig, fibroma, thecoma); (3) Poorly differentiated carcinomas mimicking AGCT. Therapeutic targets: no FDA/EMA-approved targeted therapy for FOXL2 C134W as of 2026. Investigational: (a) CDK4/6 inhibitors (palbociclib, ribociclib) — phase II trials (NCT03462186 palbociclib in GCT); (b) Olaparib (PARP inhibitor) in BRCA-wild-type GCT (Mirvetuximab + olaparib combination); (c) Bevacizumab (anti-VEGF) — phase II activity ~14%; (d) Hormonal therapies (leuprolide, megestrol, anastrozole) — common in clinical practice for recurrent disease (response rates 20–30%) but no prospective phase III data. BEP chemotherapy (bleomycin/etoposide/cisplatin) or carboplatin/paclitaxel for advanced/relapsed disease. ESCAT IIB: diagnostic and monitoring utility established; therapeutic targeting investigational.BEP (bleomycin 30 U IV day 1/8/15 + etoposide 100 mg/m² IV days 1–5 + cisplatin 20 mg/m² IV days 1–5 per 21-day cycle) — standard for advanced/recurrent AGCT
carboplatin AUC 5 + paclitaxel 175 mg/m² q3w — alternative for BEP-ineligible
leuprolide 3.75 mg IM q4w (or 11.25 mg q3m) — hormonal therapy for recurrent AGCT (off-label)
palbociclib 125 mg PO QD (days 1–21) + letrozole 2.5 mg QD (28-day cycles) — investigational; FOXL2 C134W mutation may predict CDK4/6 inhibitor sensitivity
  • SRC-NCCN-OVARIAN-2025
  • SRC-ESMO-OVARIAN-2024

Treatment options (1 tracks)

Standard plan
★ DEFAULT
Indication
IND-GRANULOSA-CELL-1L-CARBOPLATIN-PACLITAXEL
Regimen
Carboplatin + Paclitaxel (adult granulosa cell tumor, advanced/recurrent)
Drugs + NSZU
  • Carboplatin (DRUG-CARBOPLATIN) AUC 5–6 IV on Day 1 · Every 21 days · IV ⚠ NSZU — not for this indication
  • Paclitaxel (DRUG-PACLITAXEL) 175 mg/m² IV over 3 hours on Day 1 · Every 21 days · IV ⚠ NSZU — not for this indication
Reason
Engine default per algorithm ALGO-GRANULOSA-CELL-1L: {'step': 2, 'outcome': False, 'branch': {'result': 'IND-GRANULOSA-CELL-1L-CARBOPLATIN-PACLITAXEL'}, 'fired_red_flags': [], 'winner_red_flag': None}

Pre-treatment investigations

Investigations before treatment start · critical / standard / desired · merged across tracks
IDNamePriorityCategoryWhere to orderNeeded for
TEST-CBCComplete Blood Count with DifferentialCriticallab—all tracks
TEST-CMPComprehensive Metabolic PanelCriticallab—all tracks

What NOT to do

Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity
Standard plan (IND-GRANULOSA-CELL-1L-CARBOPLATIN-PACLITAXEL)
  • Do NOT ignore Inhibin B and AMH as tumor markers — primary markers for GCT response/recurrence monitoring
  • Do NOT skip paclitaxel premedication (dexamethasone + diphenhydramine + H2-blocker) — hypersensitivity risk
  • Do NOT ignore paclitaxel neuropathy — cumulative, may be permanent
  • Do NOT ignore endocrine component — estrogen excess in GCT; endometrial surveillance

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Carboplatin + Paclitaxel (adul
21-day cycles × 6 cycles (standard adjuvant/advanced); adjust for recurrent disease

MDT brief

Skills (recommended) — for consideration (1)

  • 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

Skill catalog (1/16 activated in this plan)

All registered virtual specialists. ✓ — activated for this case; ○ — not activated (available for other clinical scenarios).
Specialistskill_idVersionLast reviewedSign-offsDomain
Cellular therapy specialist (CAR-T)cellular_therapy_specialistv0.1.02026-04-250cellular_therapy
Clinical pharmacistclinical_pharmacistv0.1.02026-04-250clinical_pharmacy
Hematologist / oncohematologisthematologistv0.1.02026-04-250hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)hematopathologistv0.1.02026-04-250hematopathology
Infectious disease / hepatologyinfectious_disease_hepatologyv0.1.02026-04-250infectious_diseases
Medical oncologist (solid-tumor chemotherapist)medical_oncologistv0.1.02026-04-250solid_oncology
Molecular geneticist / molecular oncologistmolecular_geneticistv0.1.02026-04-250molecular_oncology
Palliative carepalliative_carev0.1.02026-04-250palliative_care
Pathologist (general)pathologistv0.1.02026-04-250pathology
Primary care / family physicianprimary_carev0.1.02026-04-250primary_care
Psycho-oncologistpsychologistv0.1.02026-04-250psychosocial
Radiation oncologistradiation_oncologistv0.1.02026-04-250radiation_oncology
Radiologistradiologistv0.1.02026-04-250diagnostic_imaging
Social worker / case managersocial_worker_case_managerv0.1.02026-04-250psychosocial
Surgical oncologistsurgical_oncologistv0.1.02026-04-250surgical_oncology
Transplant specialist (BMT)transplant_specialistv0.1.02026-04-250cellular_therapy

Sources cited

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).
OptionUA registrationNSZUCost orientationAccess pathway
Standard plan
Carboplatin + Paclitaxel (adult granulosa cell tumor, advanced/recurrent) (REG-CARBOPLATIN-PACLITAXEL-GCT)
✓ registered✓ covered₴-? — verify pathwayNSZU formulary

Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-05-04.

plan_id: PLAN-BMA-FOXL2_GRANULOSA_CELL-V1 | version: 1 | generated: 2026-05-04T14:13:16.597201+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.