| Biomarker | Variant | ESCAT | Evidence | Clinical significance | Drugs | Sources |
|---|---|---|---|---|---|---|
| ESCAT: clinical review pendingBIO-NF2-GERMLINE | NF2 germline pathogenic (merlin/schwannomin loss-of-function) | IIA |
Evidence cited from clinical guidelines; per-source evidence levels not yet structured. See Phase-2-of-CIViC-pivot for re-cite roadmap. | NF2 germline pathogenic variants drive Neurofibromatosis Type 2 (NF2 / NF2- related schwannomatosis) — characterized by bilateral vestibular schwannomas, meningiomas (often multiple), spinal schwannomas, ependymomas, and juvenile posterior subcapsular cataract. Confirmed-carrier surveillance protocol (per NCCN CNS / Manchester NF2 Consensus): brain MRI with contrast (thin slices through IAC) starting at age 10-12 (earlier if symptomatic) q1-2y for vestibular schwannoma and intracranial meningioma, whole-spine MRI q2-3y for spinal schwannomas and meningiomas, annual neurological exam, annual audiology (pure-tone + speech discrimination + ABR), ophthalmology exam q1-2y. Bevacizumab is active for growing or symptomatic vestibular schwannoma (hearing preservation / volume reduction in ~40-60% per Plotkin et al.) — surveillance-triggered, not prophylactic. Surgery + radiosurgery remain mainstays for accessible lesions; radiosurgery use is cautious due to malignant transformation risk in NF2. ESCAT IIA. | bevacizumab 5-7.5 mg/kg q2-3w — growing or symptomatic vestibular schwannoma in NF2 (off-label, evidence-supported per Plotkin et al. 2012) stereotactic radiosurgery — selected vestibular schwannomas, cautious (malignant transformation risk in NF2) microsurgical resection — symptomatic / brainstem-compressing schwannomas, meningiomas multidisciplinary NF2 clinic (otology, neurosurgery, neuro-oncology, genetics) |
|
| ESCAT: clinical review pendingBIO-NF2 | NF2 loss-of-function (biallelic somatic in sporadic meningioma ~50%; germline in NF2 syndrome); merlin loss by IHC acceptable surrogate | IIIA | Standard care
Resistance or avoidance signal
| NF2 loss is the most common molecular driver in meningioma (~50% of grade I; higher proportion in grade II/III). Despite its frequency, no FDA/EMA-approved targeted therapy exists specifically for NF2-mutant meningioma as of 2026. Standard treatment is maximal safe surgical resection ± radiotherapy (SRS for small residual, fractionated RT for larger/grade II-III). Systemic therapy evidence for progressive/recurrent meningioma: Selumetinib (MEK inhibitor; FDA-approved for NF1 pediatric plexiform neurofibroma): investigated in NF2-related vestibular schwannomas (ACTR-4 trial) and NF2-related meningiomas — limited hearing preservation benefit; single-agent activity modest. Bevacizumab (anti-VEGF): off-label use in progressive grade II-III meningioma or NF2-related schwannomas — radiologic responses in 40–50% in retrospective series, PFS benefit uncertain. AKT1 E17K-mutant meningioma (~10% of grade I): AKT inhibitors (capivasertib, ipatasertib) in phase II trials — not NF2-specific but relevant for co-occurring pathway alterations. SMO-mutant (~5% of meningioma): vismodegib case reports show activity. ESCAT IIB: NF2 loss is molecularly relevant but no validated targeted therapy with prospective trial data. | bevacizumab 7.5–10 mg/kg IV q3w — off-label for progressive grade II-III meningioma or NF2 syndrome-related tumors; radiologic responses in ~40–50% retrospective series selumetinib 25 mg/m² PO BID — investigational for NF2-related schwannomas (ACTR-4 regimen); not standard for meningioma |
|
| ID | Name | Priority | Category | Where to order | Needed for |
|---|---|---|---|---|---|
| TEST-CBC | Complete Blood Count with Differential | Critical | lab | — | all tracks |
| TEST-CMP | Comprehensive Metabolic Panel | Critical | lab | — | all tracks |
| TEST-LFT | Liver Function Tests (ALT, AST, bilirubin, ALP, GGT, albumin) | Critical | lab | — | all tracks |
| TEST-BRAIN-MRI-CONTRAST | Brain MRI with contrast | Standard | — | — | all tracks |
| 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 |
No active trials matched this scenario in ctgov.
| Option | UA registration | NSZU | Cost orientation | Access pathway |
|---|---|---|---|---|
| Local therapy plan — No regimen components on this track — availability unknown | — unknown | — unknown | ₴-? — verify pathway | not recorded |
Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-08-03.