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
BIO-NF2	NF2 loss-of-function (biallelic somatic in sporadic meningioma ~50%; germline in NF2 syndrome); merlin loss by IHC acceptable surrogate	IIIA	Standard care SRC-NCCN-CNS-2025: Level Category 2B (Supports, Sensitivity/Response) Resistance or avoidance signal SRC-EANO-MENINGIOMA-2024: Level B ⚠ Resistance	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	SRC-EANO-MENINGIOMA-2024 SRC-NCCN-CNS-2025

Primary current-line option

Local therapy plan

★ DEFAULT

Indication: IND-MENINGIOMA-1L-RESECTION-RT
Regimen: —
Reason: Primary current-line option selected by ALGO-MENINGIOMA-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
TEST-BRAIN-MRI-CONTRAST	Brain MRI with contrast	Standard	—	—	all tracks

What NOT to do

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

Local therapy plan (IND-MENINGIOMA-1L-RESECTION-RT)

Do not offer systemic therapy as default first-line treatment for resectable or radiation-manageable meningioma.
Do not pursue gross total resection at the cost of unacceptable neurologic morbidity; maximal safe resection is the target.
Do not omit postoperative pathology grade, brain invasion assessment, and residual-disease MRI before deciding on adjuvant RT.

MDT brief

Data quality

Complete for MDT review. Required MDT data checks are complete for the current case profile.

Biomarker coverage: 0/0 known (100%), 0 missing, 0 default-track gaps

Technical MDT skill metadata (0/16 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-EANO-MENINGIOMA-2024: EANO Guidelines on Diagnosis and Treatment of Meningiomas (2024 update) ()
SRC-NCCN-CNS-2025: NCCN Central Nervous System Cancers (v.3.2025)

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: 2026-05-12.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT06036706	Neurocognitive Impact of Different Irradiation Modalities for Patients With Grade I-II Skull Base Meningioma:	NA	RECRUITING	Centre Francois Baclesse	—	Single country
NCT04427384	Registry of Patients With Brain Tumors Treated With STaRT (GammaTiles)	N/A	RECRUITING	GT Medical Technologies, Inc.	—	Single country
NCT06132685	Post-Operative Dosing of Dexamethasone in Patients With Brain Tumors After a Craniotomy, PODS Trial	PHASE2	RECRUITING	Emory University	—	Single country
NCT06752096	Robot-Assisted Neurovascular Intervention	NA	RECRUITING	Navigantis Inc.	—	Small N (<50) Single country
NCT06874426	The Impact of Endoscopic Endonasal Skull Base Surgery on Olfaction	N/A	RECRUITING	Universitaire Ziekenhuizen KU Leuven	—	—
NCT02847559	Optune Delivered Electric Field Therapy and Bevacizumab in Treating Patients With Recurrent or Progressive Grade 2 or 3 Meningioma	PHASE2	RECRUITING	Northwestern University	—	Small N (<50) Surrogate endpoint only Single country
NCT04648462	Proton Therapy Research Infrastructure- ProTRAIT- Neuro-oncology	N/A	RECRUITING	Maastricht Radiation Oncology	—	Single country
NCT00598351	Natural History Study of Patients With Neurofibromatosis Type 2	N/A	RECRUITING	National Institute of Neurological Disorders and Stroke (NINDS)	—	Single country
NCT04278118	Hypofractionated Proton Therapy for Benign Intracranial Brain Tumors, the HiPPI Study	NA	RECRUITING	Emory University	—	Single country
NCT06830356	Somatostatin Receptor PET Imaging to Guide Radiotherapy Dose Escalation in High Risk Meningiomas.	NA	RECRUITING	Centro di Riferimento Oncologico - Aviano	—	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
Local therapy plan — No regimen components on this track — availability unknown	— unknown	— unknown	₴-? — verify pathway	not recorded
Trial · NCT06036706 Neurocognitive Impact of Different Irradiation Modalities for Patients With Grade I-II Skull Base Meningioma: No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04427384 Registry of Patients With Brain Tumors Treated With STaRT (GammaTiles) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06132685 Post-Operative Dosing of Dexamethasone in Patients With Brain Tumors After a Craniotomy, PODS Trial No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06752096 Robot-Assisted Neurovascular Intervention No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06874426 The Impact of Endoscopic Endonasal Skull Base Surgery on Olfaction No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT02847559 Optune Delivered Electric Field Therapy and Bevacizumab in Treating Patients With Recurrent or Progressive Grade 2 or 3 Meningioma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04648462 Proton Therapy Research Infrastructure- ProTRAIT- Neuro-oncology No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT00598351 Natural History Study of Patients With Neurofibromatosis Type 2 No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04278118 Hypofractionated Proton Therapy for Benign Intracranial Brain Tumors, the HiPPI Study No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06830356 Somatostatin Receptor PET Imaging to Guide Radiotherapy Dose Escalation in High Risk Meningiomas. 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-MENINGIOMA-001-V1 | version: 1 | generated: 2026-05-12T18:41:26.061957+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.