Patient
COVERAGE-GRANULOSA-CELL-001 · Algorithm: ALGO-GRANULOSA-CELL-1L
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
- 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
- Primary current-line option selected by ALGO-GRANULOSA-CELL-1L at step 2.
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 |
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 (adult granulosa cell tumor, advanced/recurrent)
21-day cycles × 6 cycles (standard adjuvant/advanced); adjust for recurrent disease
MDT brief
Discussion questions (1, 1 blocking)
BLOCKING OQ-BIOMARKER-FOXL2
What is the status of FOXL2 p.C134W mutation (BIO-FOXL2)? It is required by track(s): IND-GRANULOSA-CELL-1L-CARBOPLATIN-PACLITAXEL. Expected value: FOXL2 C134W mutation — confirms adult GCT diagnosis (near-pathognomonic ~97%); not a therapeutic selection marker.
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 FOXL2 p.C134W mutation (BIO-FOXL2)? It is required by track(s): IND-GRANULOSA-CELL-1L-CARBOPLATIN-PACLITAXEL. Expected value: FOXL2 C134W mutation — confirms adult GCT diagnosis (near-pathognomonic ~97%); not a therapeutic selection marker. |
Skills (recommended) — for consideration (1)
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-FOXL2 | FOXL2 p.C134W mutation | molecular_geneticist | yes | IND-GRANULOSA-CELL-1L-CARBOPLATIN-PACLITAXEL | Verify result, method, specimen, and report date before sign-off. Expected/constraint: FOXL2 C134W mutation — confirms adult GCT diagnosis (near-pathognomonic ~97%); not a therapeutic selection marker |
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 | 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 |
Sources cited
- SRC-ESMO-OVARIAN-2024: ESMO Ovarian Cancer Clinical Practice Guideline (2024)
- SRC-NCCN-OVARIAN-2025: NCCN Ovarian Cancer (v.2.2025)
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: 2026-05-13.
| NCT | Title | Phase | Status | Sponsor | UA | Signals | Eligibility (excerpt) |
|---|
| NCT05872204 | Abemaciclib and Letrozole in Patients With Estrogen Receptor-positive Rare Ovarian Cancer | PHASE2 | RECRUITING | — | Surrogate endpoint only | |
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 Carboplatin + Paclitaxel (adult granulosa cell tumor, advanced/recurrent) (REG-CARBOPLATIN-PACLITAXEL-GCT) | ✓ registered | ✓ covered | ₴-? — verify pathway | NSZU formulary |
| Trial · NCT05872204 Abemaciclib and Letrozole in Patients With Estrogen Receptor-positive Rare Ovarian Cancer 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: 2026-05-13.