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OpenOnco · DIS-THYROID-PAPILLARY · BIO-RET (ESCAT IB)
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OpenOnco · Treatment Plan
Treatment plan — DIS-THYROID-PAPILLARY
PLAN-BMA-RET_FUSION_THYROID_PAPILLARY-V1 · v1 · 2026-05-04
Patient
BMA-RET_FUSION_THYROID_PAPILLARY · Algorithm: ALGO-THYROID-PAPILLARY-1L

Clinical significance of mutations (ESCAT)

Tumor-board context — the engine does not use these tiers to rank tracks
BiomarkerVariantESCATEvidenceClinical significanceDrugsSources
BIO-RETfusion (CCDC6-RET, NCOA4-RET, ELKS-RET et al.) — distinct from MTC mutationsIB
  • SRC-CIVIC: Level A (Supports, Sensitivity/Response)
  • SRC-CIVIC: Level B (Supports, Sensitivity/Response)
  • SRC-CIVIC: Level C ⚠ Resistance
  • SRC-CIVIC: Level C (Supports, Sensitivity/Response)
RET fusion in papillary thyroid carcinoma (PTC) — ~5-10% sporadic, enriched in radiation-induced PTC. Selpercatinib (LIBRETTO-001 PTC cohort, Wirth 2020 — ORR 79%) and pralsetinib (ARROW PTC cohort, ORR 89%) are FDA-approved for RAI-refractory advanced disease. Selective RET-TKIs are preferred over sorafenib / lenvatinib for RET-fusion-positive RAI-refractory disease.selpercatinib monotherapy (RAI-refractory advanced disease)
pralsetinib monotherapy
  • SRC-NCCN-CNS-2025

Treatment options (1 tracks)

Standard plan
★ DEFAULT
Indication
IND-THYROID-PAPILLARY-RAI-REFRACTORY-LENVATINIB
Regimen
Lenvatinib monotherapy (RAI-refractory progressive PTC, 1L systemic)
Drugs + NSZU
  • Lenvatinib (DRUG-LENVATINIB) 24 mg PO daily, continuous · Per regimen schedule · IV ⚠ NSZU — not for this indication
Reason
Engine default per algorithm ALGO-THYROID-PAPILLARY-1L: {'step': None, 'note': 'decision tree fell through; using default_indication', 'result': 'IND-THYROID-PAPILLARY-RAI-REFRACTORY-LENVATINIB', 'fired_red_flags': []}

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Lenvatinib monotherapy (RAI-re
21-day cycles × 6 cycles or until progression / toxicity

MDT brief

Data quality

  • Unevaluated RedFlags: RF-THYROID-PAPILLARY-FRAILTY-AGE, RF-THYROID-PAPILLARY-HIGH-RISK-BIOLOGY, RF-THYROID-PAPILLARY-INFECTION-SCREENING, RF-THYROID-PAPILLARY-ORGAN-DYSFUNCTION, RF-THYROID-PAPILLARY-TRANSFORMATION-PROGRESSION

Skill catalog (0/16 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)

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.
NCTTitlePhaseStatusSponsorUAEligibility (excerpt)
NCT05668962Restor. I-131 Upt. + Selpercatinib in RET F-P RAI-R TCPHASE2RECRUITINGMassachusetts General Hospital—

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).
OptionUA registrationNSZUCost orientationAccess pathway
Standard plan
Lenvatinib monotherapy (RAI-refractory progressive PTC, 1L systemic) (REG-LENVATINIB-THYROID-RAI-REF)
✓ registered✓ covered₴-? — verify pathwayNSZU formulary
Trial · NCT05668962
Restor. I-131 Upt. + Selpercatinib in RET F-P RAI-R TC
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-RET_FUSION_THYROID_PAPILLARY-V1 | version: 1 | generated: 2026-05-04T14:13:16.642595+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.