OpenOnco · Treatment Plan

Treatment plan — Epithelioid sarcoma

PLAN-COVERAGE-EPITHELIOID-SARCOMA-001-V1 · v1 · 2026-05-12

Patient

COVERAGE-EPITHELIOID-SARCOMA-001 · Algorithm: ALGO-EPITHELIOID-SARCOMA-1L

DiagnosisEpithelioid sarcoma

MOH / ICD-10C49

ICD-O-38804/3; C49

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
No clinically actionable variants matched in this profile.

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-EPITHELIOID-SARCOMA-1L-TAZEMETOSTAT

Regimen

Tazemetostat monotherapy (advanced epithelioid sarcoma, SMARCB1/INI1-deficient)

Drugs + NSZU

Tazemetostat (DRUG-TAZEMETOSTAT) 800 mg PO twice daily (1600 mg/day total) · Continuous until progression or unacceptable toxicity · PO ✗ Not registered in UA

Reason

Primary current-line option selected by ALGO-EPITHELIOID-SARCOMA-1L at step 1.

Pre-treatment investigations

Investigations before treatment start · critical / standard / desired · merged across tracks

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

What NOT to do

Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity

Standard plan (IND-EPITHELIOID-SARCOMA-1L-TAZEMETOSTAT)

Do NOT prescribe without confirmed SMARCB1/INI1 loss by IHC — mandatory eligibility criterion
Do NOT combine with strong CYP3A4 inhibitors without dose reduction (reduce to 400 mg BID)
Do NOT ignore secondary malignancy risk — T-LBL/AML reported in pediatric sarcoma trials
Do NOT prescribe in pregnancy — embryo-fetal toxicity

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Tazemetostat monotherapy (advanced epithelioid sarcoma, SMARCB1/INI1-deficient)

28-day cycles × Continuous until progression

MDT brief

Discussion questions (1, 1 blocking)

BLOCKING OQ-BIOMARKER-SMARCB1
What is the status of SMARCB1 (INI1) loss of expression (BIO-SMARCB1)? It is required by track(s): IND-EPITHELIOID-SARCOMA-1L-TAZEMETOSTAT. Expected value: SMARCB1/INI1 loss by IHC (mandatory companion diagnostic for FDA approval).
A treatment-track biomarker requirement is missing from the patient profile; the MDT should verify the test result, method, specimen, and date before relying on this option.
→ molecular_geneticist

MDT talk tree (1 steps)

#	Owner	Topic	Action
1	molecular_geneticist	Biomarker status BLOCKING	What is the status of SMARCB1 (INI1) loss of expression (BIO-SMARCB1)? It is required by track(s): IND-EPITHELIOID-SARCOMA-1L-TAZEMETOSTAT. Expected value: SMARCB1/INI1 loss by IHC (mandatory companion diagnostic for FDA approval).

Skills (recommended) — for consideration (1)

Molecular geneticist / molecular oncologist recommended
Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.
Owns: OQ-BIOMARKER-SMARCB1

Data quality

Incomplete for default-track review. Default-track review is incomplete until required biomarker gaps are resolved.

Biomarker coverage: 0/1 known (0%), 1 missing, 1 default-track gaps

Missing biomarker	Label	MDT owner	Default track	Required by	Next action
`BIO-SMARCB1`	SMARCB1 (INI1) loss of expression	molecular_geneticist	yes	IND-EPITHELIOID-SARCOMA-1L-TAZEMETOSTAT	Verify result, method, specimen, and report date before sign-off. Expected/constraint: SMARCB1/INI1 loss by IHC (mandatory companion diagnostic for FDA approval)

Technical MDT skill metadata (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	Domain
Cellular therapy specialist (CAR-T)	`cellular_therapy_specialist`	v0.1.0	2026-04-25	cellular_therapy
Clinical pharmacist	`clinical_pharmacist`	v0.1.0	2026-04-25	clinical_pharmacy
Hematologist / oncohematologist	`hematologist`	v0.1.0	2026-04-25	hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)	`hematopathologist`	v0.1.0	2026-04-25	hematopathology
Infectious disease / hepatology	`infectious_disease_hepatology`	v0.1.0	2026-04-25	infectious_diseases
Medical oncologist (solid-tumor chemotherapist)	`medical_oncologist`	v0.1.0	2026-04-25	solid_oncology
Molecular geneticist / molecular oncologist	`molecular_geneticist`	v0.1.0	2026-04-25	molecular_oncology
Palliative care	`palliative_care`	v0.1.0	2026-04-25	palliative_care
Pathologist (general)	`pathologist`	v0.1.0	2026-04-25	pathology
Primary care / family physician	`primary_care`	v0.1.0	2026-04-25	primary_care
Psycho-oncologist	`psychologist`	v0.1.0	2026-04-25	psychosocial
Radiation oncologist	`radiation_oncologist`	v0.1.0	2026-04-25	radiation_oncology
Radiologist	`radiologist`	v0.1.0	2026-04-25	diagnostic_imaging
Social worker / case manager	`social_worker_case_manager`	v0.1.0	2026-04-25	psychosocial
Surgical oncologist	`surgical_oncologist`	v0.1.0	2026-04-25	surgical_oncology
Transplant specialist (BMT)	`transplant_specialist`	v0.1.0	2026-04-25	cellular_therapy

Sources cited

SRC-ESMO-SARCOMA-2024: ESMO soft-tissue sarcoma guideline (2024) (TODO: confirm citation) ()
SRC-EZH202-GOUNDER-2020: EZH-202: Tazemetostat in Epithelioid Sarcoma (Gounder et al., Lancet Oncology 2020) ()

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: 2026-05-12.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT07467772	Ph 2 Elacestrant in ER Positive Uterine Sarcomas	PHASE2	RECRUITING	Dana-Farber Cancer Institute	—	Small N (<50) Surrogate endpoint only Single country
NCT06715579	Cardiac Angiosarcoma International Registry	N/A	RECRUITING	Immune Oncology Research Institute	—	Single country
NCT03099681	An Observational Study on Epithelioid Sarcoma	N/A	RECRUITING	Italian Sarcoma Group	—	Single country
NCT04300257	Swiss Sarcoma Network: Prediction Model for Patient Selection in Sarcoma Care	N/A	RECRUITING	Kantonsspital Winterthur KSW	—	Single country
NCT07089992	A Study of Pembrolizumab in People With Ultra-Rare Sarcomas	PHASE2	RECRUITING	Memorial Sloan Kettering Cancer Center	—	Small N (<50) Surrogate endpoint only Single country
NCT06683846	Ivonescimab in the Treatment of Multiple Advanced Tumors	PHASE2	RECRUITING	Fudan University	—	Surrogate endpoint only Single country
NCT06277154	MASCT-I Combined With Doxorubicin and Ifosfamide for First-line Treatment of Advanced Soft Tissue Sarcoma	PHASE2	RECRUITING	HRYZ Biotech Co.	—	Surrogate endpoint only Single country
NCT06408441	The Epithelioid Hemangioendothelioma Registry of the European Reference Network on Rare Adult Solid Cancers (EURACAN)	N/A	RECRUITING	Fondazione IRCCS Istituto Nazionale dei Tumori, Milano	—	—
NCT06239272	NRSTS2021, A Risk Adapted Study Evaluating Maintenance Pazopanib, Limited Margin, Dose-Escalated Radiation Therapy and Selinexor in Non-Rhabdomyosarcoma Soft Tissue Sarcoma (NRSTS)	PHASE1 / PHASE2	RECRUITING	St. Jude Children's Research Hospital	—	Single country
NCT03967834	Multimodal Immune Characterization of RAre Soft Tissue Sarcoma - MIRAS Project From SARRA (SARcome RAre) Project of the French Sarcoma Group	NA	RECRUITING	Institut Claudius Regaud	—	Surrogate endpoint only Single country

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).

Option	UA registration	NSZU	Cost orientation	Access pathway
Standard plan Tazemetostat monotherapy (advanced epithelioid sarcoma, SMARCB1/INI1-deficient) (REG-TAZEMETOSTAT-EPITHELIOID-SARCOMA) 1/1 component drug(s) not registered in Ukraine +1	✗ not registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Trial · NCT07467772 Ph 2 Elacestrant in ER Positive Uterine Sarcomas No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06715579 Cardiac Angiosarcoma International Registry No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03099681 An Observational Study on Epithelioid Sarcoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04300257 Swiss Sarcoma Network: Prediction Model for Patient Selection in Sarcoma Care No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07089992 A Study of Pembrolizumab in People With Ultra-Rare Sarcomas No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06683846 Ivonescimab in the Treatment of Multiple Advanced Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06277154 MASCT-I Combined With Doxorubicin and Ifosfamide for First-line Treatment of Advanced Soft Tissue Sarcoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06408441 The Epithelioid Hemangioendothelioma Registry of the European Reference Network on Rare Adult Solid Cancers (EURACAN) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06239272 NRSTS2021, A Risk Adapted Study Evaluating Maintenance Pazopanib, Limited Margin, Dose-Escalated Radiation Therapy and Selinexor in Non-Rhabdomyosarcoma Soft Tissue Sarcoma (NRSTS) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03967834 Multimodal Immune Characterization of RAre Soft Tissue Sarcoma - MIRAS Project From SARRA (SARcome RAre) Project of the French Sarcoma Group 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: 2026-05-12.

plan_id: PLAN-COVERAGE-EPITHELIOID-SARCOMA-001-V1 | version: 1 | generated: 2026-05-12T18:41:25.991814+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.