OpenOnco · Treatment Plan

Treatment plan — Malignant mesothelioma

PLAN-COVERAGE-MESOTHELIOMA-001-V1 · v1 · 2026-08-17

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: 2026-08-17.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT05873686	A Phase 1 Clinical Study of NXP900 in Subjects With Advanced Cancers	PHASE1	RECRUITING	Nuvectis Pharma, Inc.	—	Phase 1 only Surrogate endpoint only
NCT07234058	Trial Assessing Fianlimab Plus Cemiplimab Plus Chemotherapy or Cemiplimab Plus Chemotherapy in Patients With Pleural Mesothelioma	PHASE2	RECRUITING	Intergroupe Francophone de Cancerologie Thoracique	—	Single country
NCT05655078	Hemithoracic Irradiation With Proton Therapy in Malignant Pleural Mesothelioma	NA	RECRUITING	University College, London	—	Single country
NCT06196294	GPC3/Mesothelin-CAR-γδT Cells Against Cancers	PHASE1	RECRUITING	Second Affiliated Hospital of Guangzhou Medical University	—	Phase 1 only Small N (<50) Single country
NCT04996017	Atezolizumab Versus Placebo for the Adjuvant Treatment of Malignant Pleural Mesothelioma (Atezomeso)	PHASE3	RECRUITING	Gruppo Oncologico Italiano di Ricerca Clinica	—	Surrogate endpoint only Single country
NCT05568680	SynKIR-110 for Mesothelin Expressing Ovarian Cancer, Cholangiocarcinoma or Mesothelioma	PHASE1	RECRUITING	Verismo Therapeutics	—	Phase 1 only Small N (<50) Single country
NCT05932199	Neoadjuvant Durvalumab and Tremelimumab With and Without Chemotherapy for Mesothelioma	PHASE1 / PHASE2	RECRUITING	Baylor College of Medicine	—	Single country
NCT07532902	A Study of BMS-986504 With Standard-of-Care Therapy for People With Solid Tumor Cancer	PHASE1	RECRUITING	Memorial Sloan Kettering Cancer Center	—	Phase 1 only Single country
NCT06051695	A Study to Evaluate the Safety and Efficacy of Mesothelin-Targeting Logic-gated CAR T, in Participants With Solid Tumors That Express MSLN and Have Lost HLA-A*02 Expression	PHASE1 / PHASE2	RECRUITING	A2 Biotherapeutics Inc.	—	Surrogate endpoint only Single country
NCT07192900	Fast TILs to Treat Metastatic Cancer Patients With Pleural Disease	PHASE1	RECRUITING	David Bartlett, MD	—	Phase 1 only 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 · NCT05873686 A Phase 1 Clinical Study of NXP900 in Subjects With Advanced Cancers No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07234058 Trial Assessing Fianlimab Plus Cemiplimab Plus Chemotherapy or Cemiplimab Plus Chemotherapy in Patients With Pleural Mesothelioma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05655078 Hemithoracic Irradiation With Proton Therapy in Malignant Pleural Mesothelioma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06196294 GPC3/Mesothelin-CAR-γδT Cells Against Cancers No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04996017 Atezolizumab Versus Placebo for the Adjuvant Treatment of Malignant Pleural Mesothelioma (Atezomeso) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05568680 SynKIR-110 for Mesothelin Expressing Ovarian Cancer, Cholangiocarcinoma or 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 · NCT07532902 A Study of BMS-986504 With Standard-of-Care Therapy for People With Solid Tumor Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06051695 A Study to Evaluate the Safety and Efficacy of Mesothelin-Targeting Logic-gated CAR T, in Participants With Solid Tumors That Express MSLN and Have Lost HLA-A*02 Expression No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07192900 Fast TILs to Treat Metastatic Cancer Patients With Pleural Disease 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: 2026-08-17.

plan_id: PLAN-COVERAGE-MESOTHELIOMA-001-V1 | version: 1 | generated: 2026-08-17T08:06:30.881707+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.