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OpenOnco · DIS-THYROID-PAPILLARY · BIO-TERT (ESCAT IIB)
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OpenOnco · Treatment Plan
Treatment plan — DIS-THYROID-PAPILLARY
PLAN-BMA-TERT_THYROID-V1 · v1 · 2026-05-04
Patient
BMA-TERT_THYROID · 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-TERTTERT promoter mutation (C228T or C250T) in papillary or follicular thyroid carcinoma — adverse prognostic marker; synergistic mortality risk when co-occurring with BRAF V600EIIB
  • SRC-NCCN-THYROID-2025: Level Category 2A (Supports, Poor Outcome)
  • SRC-ATA-THYROID-2015: Level B (Supports, Poor Outcome)
TERT promoter mutations (C228T or C250T) occur in ~10–15% of papillary thyroid cancer (PTC) and ~15–20% of follicular thyroid cancer (FTC). TERT mutation is a strong adverse prognostic marker in differentiated thyroid cancer. Key evidence: Xing et al. (NEJM 2014 correspondence / JAMA Oncol): BRAF V600E + TERT promoter mutation creates a synergistic mortality risk — patients with both mutations have ~40× higher disease-specific mortality vs those with neither (BRAF+TERT double-positive: ~68% 10-yr mortality vs ~2% wild-type). TERT alone or BRAF alone: intermediate risk. ATA 2015 guidelines incorporate BRAF V600E as a risk-stratification factor; ESMO/NCCN 2025 updates recommend TERT testing alongside BRAF to identify the highest-risk PTC subgroup. Therapeutic implication: TERT-mutant/BRAF-mutant PTC should receive more aggressive radioiodine (RAI) therapy and enhanced surveillance. RAI-refractory TERT/BRAF-double- mutant PTC may benefit from kinase inhibitors (sorafenib, lenvatinib). No TERT-specific inhibitor approved for thyroid cancer. ESCAT IIB: established prognostic biomarker; no direct therapeutic target, but guides treatment intensity.Radioactive iodine (RAI) — intensified dosing strategy for TERT+BRAF double-positive PTC (consider 150–200 mCi therapeutic dose with TSH stimulation for high-risk features)
lenvatinib 24 mg PO QD — for RAI-refractory differentiated thyroid cancer (SELECT trial; FDA 2015); TERT mutation predicts RAI-refractoriness; not TERT-specific approval
sorafenib 400 mg PO BID — RAI-refractory DTC (DECISION trial; FDA 2013; alternative to lenvatinib)
  • SRC-NCCN-THYROID-2025
  • SRC-ATA-THYROID-2015

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)

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
Lenvatinib monotherapy (RAI-refractory progressive PTC, 1L systemic) (REG-LENVATINIB-THYROID-RAI-REF)
✓ 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-TERT_THYROID-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.