OpenOnco · Treatment Plan

Treatment plan — Malignant mesothelioma

PLAN-COVERAGE-MESOTHELIOMA-001-V1 · v1 · 2026-08-18

Patient

COVERAGE-MESOTHELIOMA-001 · Algorithm: ALGO-MESOTHELIOMA-1L

DiagnosisMalignant mesothelioma

MOH / ICD-10C45.0

ICD-O-39050/3; C38.4, C48.1, C48.2

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-MESOTHELIOMA-1L-NIVO-IPI

Regimen

Nivolumab + ipilimumab (mesothelioma, 1L)

Drugs + NSZU

Nivolumab (DRUG-NIVOLUMAB) 3 mg/kg IV over 30 min, day 1 · q14 days (every 2 weeks); up to 2 years · IV ⚠ NSZU — not for this indication
Ipilimumab (DRUG-IPILIMUMAB) 1 mg/kg IV over 30 min, day 1 (same day as nivolumab) · q42 days (every 6 weeks); up to 2 years · IV ⚠ NSZU — not for this indication

Reason

Provisional current-line default from ALGO-MESOTHELIOMA-1L: step 1 did not select a treatment branch. Potentially resectable MPM: evaluate for EPP (extrapleural pneumonectomy) or P/D (pleurectomy/decortication) with neoadjuvant or adjuvant intent at high-volume thoracic surgery center. Multimodality approach (surgery + chemotherapy ± RT) discussed in MDT. If resection attempted...

Other current-line alternatives (1 tracks)

Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.

Standard plan

Indication

IND-MESOTHELIOMA-1L-PEMETREXED-PLATINUM

Regimen

Pemetrexed + cisplatin (malignant pleural mesothelioma, 1L)

Drugs + NSZU

Pemetrexed (DRUG-PEMETREXED) 500 mg/m² IV over 10 min · Day 1 of each 21-day cycle · IV ✓ NSZU covered
Cisplatin (DRUG-CISPLATIN) 75 mg/m² IV over 2h with aggressive hydration · Day 1, 30 minutes after pemetrexed completion · IV ⚠ NSZU — not for this indication

Reason

Current-line alternative presented for HCP consideration

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-CREATININE-CL	Creatinine clearance	Critical	lab	—	all tracks
TEST-CT-CHEST-ABDOMEN-PELVIS	CT chest + abdomen + pelvis with IV contrast	Critical	imaging	—	all tracks
TEST-HBV-SEROLOGY	Hepatitis B Serology Panel (HBsAg, anti-HBc total, anti-HBs)	Critical	lab	—	all tracks
TEST-HCV-ANTIBODY	HCV Antibody	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	—	—	desired (standard)
TEST-CORTISOL-MORNING	Morning cortisol	Standard	lab	—	desired (standard)
TEST-CT-CAP	CT chest/abdomen/pelvis	Standard	imaging	—	all tracks
TEST-LVEF-ECHO	Echocardiogram with LVEF	Standard	clinical_assessment	—	all tracks
TEST-PFT-SPIROMETRY	Pulmonary function tests / spirometry	Standard	clinical_assessment	—	all tracks
TEST-TSH	Thyroid-stimulating hormone	Standard	lab	—	all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Active TB OR latent TB conversion risk — ICI may trigger TB reactivation; pre-treatment IGRA / TST + chest imaging recommended.
Ukraine is an HBV/HCV/TB high-prevalence region — pre-ICI screen more important than in low-prevalence settings. HBV reactivation risk handled by RF-UNIVERSAL-HBV-REACTIVATION-RISK.
RF-NSCLC-INFECTION-SCREENINGSRC-NCCN-NSCLC-2025SRC-ESMO-NSCLC-METASTATIC-2024

CONTRA-AGGRESSIVE

Hard contraindications to escalation

What NOT to do

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

Standard plan (IND-MESOTHELIOMA-1L-NIVO-IPI)

Не використовувати дозу noволумабу 360 мг q3w або 480 мг q4w — МПМ-специфічне дозування 3 мг/кг q2w (ваговe); з CheckMate-743
Не використовувати дозу іпілімумабу 3 мг/кг або q3w схему — МПМ-специфічне: 1 мг/кг q6w (вагове), НЕ як при меланомі або НМКЛЛі
Не починати без базового скриnoнгу HBV/HCV + тиреоїдна функція + LFTs + кортизол
Не вводити інфліксімаб при CTLA-4-пов'язаному Grade 3+ гепатиті — застосувати мікофенолат мофетил; інфліксімаб протипоказаний при гепатиті (ризик фульмінантного некрозу)
Не оцінювати відповідь за стандартним RECIST 1.1 — МПМ вимагає модифікованого RECIST (двовимірне плевральне вимірювання)
Не призначати при активному аутоімунному захворюванno, що вимагає >10 мг/д предnoзолону, або при попередnoй трансплантації оргаnoв

Standard plan (IND-MESOTHELIOMA-1L-PEMETREXED-PLATINUM)

НІКОЛИ не призначати пеметрексед без фолієвої кислоти + вітаміну B12 — без добавок Grade 3/4 токсичnoсть ~60% (проти ~18% з добавками)
Не призначати пеметрексед при КК <45 мл/хв
Не оцінювати відповідь за стандартними RECIST 1.1 — МПМ вимагає модифікованих RECIST (площинno вимірювання плеврального ущільнення)

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Nivolumab + ipilimumab (mesothelioma, 1L)

14-day cycles × Up to 2 years total (nivo continuous q2w; ipi q6w); discontinue earlier for progression or unacceptable toxicity

Standard plan

Induction · Pemetrexed + cisplatin (malignant pleural mesothelioma, 1L)

21-day cycles × 6 cycles (standard; response-guided)

MDT brief

Data quality

Usable with caveats. No critical default-track gap was found, but the MDT should review the listed caveats before final sign-off.

Biomarker coverage: 0/0 known (100%), 0 missing, 0 default-track gaps
Unevaluated RedFlags: RF-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISK, RF-BAP1-CONFIRMED-CARRIER, RF-BAP1-FAMILY-HISTORY-SUSPICION, RF-OCC-ASBESTOS-MALIGNANCY-PREVENTION, RF-OCC-FIREFIGHTER-PREVENTION

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-CHECKMATE-743-BAAS-2021: First-line nivolumab plus ipilimumab in unresectable malignant pleural mesothelioma (CheckMate 743): a multicentre, randomised, open-label, phase 3 trial ()
SRC-EMPHACIS-VOGELZANG-2003: Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma ()
SRC-NCCN-NSCLC-2025: NCCN Clinical Practice Guidelines — Non-Small Cell Lung Cancer (2025.v8)

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: 2026-08-18.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT05188859	First Line Sintilimab Combined With Anlotinib and Platinum Doublet Chemotherapy in Malignant Pleural Mesothelioma	PHASE2	RECRUITING	Cancer Institute and Hospital, Chinese Academy of Medical Sciences	—	Small N (<50) Surrogate endpoint only Single country
NCT00242723	Evaluation of Cell Changes in Blood and Tissue in Cancers of the Lung, Esophagus and Lung Lining	N/A	RECRUITING	National Cancer Institute (NCI)	—	Single country
NCT06566079	Study of ISM6331 in Participants With Advanced/Metastatic Malignant Mesothelioma or Other Solid Tumors	PHASE1	RECRUITING	InSilico Medicine Hong Kong Limited	—	Phase 1 only
NCT04515836	Olaparib in Patients With HRD Malignant Mesothelioma	PHASE2	RECRUITING	University of Chicago	—	Surrogate endpoint only Single country
NCT05932199	Neoadjuvant Durvalumab and Tremelimumab With and Without Chemotherapy for Mesothelioma	PHASE1 / PHASE2	RECRUITING	Baylor College of Medicine	—	Single country
NCT05086692	A Beta-only IL-2 ImmunoTherapY Study	PHASE1 / PHASE2	RECRUITING	Medicenna Therapeutics, Inc.	—	—
NCT05647265	Testing the Addition of Immunotherapy Before Surgery for Patients With Sarcomatoid Mesothelioma	PHASE2	RECRUITING	Alliance for Clinical Trials in Oncology	—	Small N (<50) Surrogate endpoint only Single country
NCT05538806	TTFields in General Routine Clinical Care in Patients With Pleural Mesothelioma Study	N/A	RECRUITING	NovoCure Ltd.	—	—
NCT05304208	dENdritic Cell Therapy Combined With SURgEry in Mesothelioma	PHASE1	RECRUITING	Erasmus Medical Center	—	Phase 1 only Small N (<50) Single country
NCT05765084	Integration of the PD-L1 Inhibitor Atezolizumab and WT1/DC Vaccination Into Platinum/Pemetrexed-based First-line Treatment for Epithelioid Malignant Pleural Mesothelioma	PHASE1 / PHASE2	RECRUITING	University Hospital, Antwerp	—	Small N (<50) 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 Nivolumab + ipilimumab (mesothelioma, 1L) (REG-NIVO-IPI-MESOTHELIOMA)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Standard plan Pemetrexed + cisplatin (malignant pleural mesothelioma, 1L) (REG-PEMETREXED-CISPLATIN-MPM)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT05188859 First Line Sintilimab Combined With Anlotinib and Platinum Doublet Chemotherapy in Malignant Pleural Mesothelioma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT00242723 Evaluation of Cell Changes in Blood and Tissue in Cancers of the Lung, Esophagus and Lung Lining No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06566079 Study of ISM6331 in Participants With Advanced/Metastatic Malignant Mesothelioma or Other Solid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04515836 Olaparib in Patients With HRD Malignant Mesothelioma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05932199 Neoadjuvant Durvalumab and Tremelimumab With and Without Chemotherapy for Mesothelioma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05086692 A Beta-only IL-2 ImmunoTherapY Study No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05647265 Testing the Addition of Immunotherapy Before Surgery for Patients With Sarcomatoid Mesothelioma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05538806 TTFields in General Routine Clinical Care in Patients With Pleural Mesothelioma Study No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05304208 dENdritic Cell Therapy Combined With SURgEry in Mesothelioma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05765084 Integration of the PD-L1 Inhibitor Atezolizumab and WT1/DC Vaccination Into Platinum/Pemetrexed-based First-line Treatment for Epithelioid Malignant Pleural Mesothelioma 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: 2026-08-18.

plan_id: PLAN-COVERAGE-MESOTHELIOMA-001-V1 | version: 1 | generated: 2026-08-18T07:59:48.442450+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.