OpenOnco · Treatment Plan

Treatment plan — Pancreatic neuroendocrine tumor

PLAN-COVERAGE-PNET-001-V1 · v1 · 2026-06-27

Patient

COVERAGE-PNET-001 · Algorithm: ALGO-PNET-METASTATIC-1L

DiagnosisPancreatic neuroendocrine tumor

MOH / ICD-10C25.4

ICD-O-38240/3; C25

Clinical significance of mutations (ESCAT)

Tumor-board context — the engine does not use these tiers to rank tracks

✅ Covered biomarkers (matched in KB)

Biomarker	Variant	ESCAT	Evidence	Clinical significance	Drugs	Sources
No clinically actionable variants matched in this profile.

⚠️ Not included in plan

Biomarker	Status
BIO-KI67-PROLIFERATION	Not in KB — ask clinician to verify

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-PNET-METASTATIC-1L-EVEROLIMUS

Regimen

Everolimus monotherapy (advanced/progressive pNET G1/G2; RADIANT-3)

Drugs + NSZU

Everolimus (DRUG-EVEROLIMUS) 10 mg PO once daily · Continuous daily dosing until progression or unacceptable toxicity · PO ⚠ Out-of-pocket

Supportive care

SUP-PJP-PROPHYLAXIS

Reason

Primary current-line option selected by ALGO-PNET-METASTATIC-1L at step 2; branch-driving red flag: RF-FITNESS-ECOG-FIT.

Why this branch was chosen

Triggers from the patient profile that fired and drove the chosen branch.

Step 2 → branch IND-PNET-METASTATIC-1L-EVEROLIMUS

RF-FITNESS-ECOG-FIT ★ winner: —

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Poor performance status (ECOG ≥3): patient capable of only limited self-care, confined to bed/chair >50% of waking hours, or completely disabled. Generally palliative/best-supportive-care intent; cytotoxic therapy at full dose contraindicated. Selective targeted-therapy or steroid debulk may be appropriate as bridge to reassessment. RF-FITNESS-ECOG-POOR
Well-differentiated or poorly-differentiated neuroendocrine tumor with Ki67 >20% (WHO 2019 G3). High-grade disease is clinically and therapeutically distinct from G1/G2: well-differentiated G3 pNET may still respond to everolimus/sunitinib/SSA but outcomes are inferior; poorly differentiated neuroendocrine carcinoma (NEC, Ki67 typically >55%) requires platinum- etoposide chemotherapy (CAPEOX/EP/IP). Engine flag routes to MDT review. RF-NET-HIGH-GRADE-G3

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-PNET-METASTATIC-1L-EVEROLIMUS)

Не призначати еверолімус при погано-диференційоваnoй NEC (Ki67 >55%) — потрібна хіміотерапія (EP)
Не починати без базового тестування Ki67 — градуювання є вимогою відбору
Не застосовувати з сильними інгібіторами CYP3A4 без корекції дози (зниження до 2.5 мг/добу)
Уникати живих вакцин на фоno еверолімусу (імуносупресія)

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Everolimus monotherapy (advanced/progressive pNET G1/G2; RADIANT-3)

28-day cycles × Continuous until progression or unacceptable toxicity

MDT brief

MDT talk tree (1 steps)

#	Owner	Topic	Action
1	social_worker_case_manager	Specialist review	Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.

Skills (recommended) — for consideration (1)

Social worker / case manager recommended
Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.

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: 1/1 known (100%), 0 missing, 0 default-track gaps
Unevaluated RedFlags: RF-MEN1-CONFIRMED-CARRIER, RF-MEN1-FAMILY-HISTORY-SUSPICION, RF-NET-CARCINOID-SYNDROME, RF-NET-HIGH-GRADE-G3

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-NCCN-NET-2025: NCCN Neuroendocrine and Adrenal Tumors (v.2.2025)
SRC-RADIANT3-YAO-2011: Everolimus for Advanced Pancreatic Neuroendocrine Tumors (RADIANT-3; phase III) (None)

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: 2026-06-27.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT06016855	Surgical Debulking Prior to Peptide Receptor Radionuclide Therapy in Well Differentiated Gastroenteropancreatic Neuroendocrine Tumors	PHASE4	RECRUITING	Vanderbilt-Ingram Cancer Center	—	Small N (<50) Single country
NCT06596915	Safety and Efficacy of BA1302 in Patients With Advanced Solid Tumors	PHASE1	RECRUITING	Shandong Boan Biotechnology Co., Ltd	—	Phase 1 only Single country
NCT03454035	Ulixertinib/Palbociclib in Patients With Advanced Pancreatic and Other Solid Tumors	PHASE1	RECRUITING	UNC Lineberger Comprehensive Cancer Center	—	Phase 1 only Small N (<50) Single country
NCT04373564	Effect on Body Movement and Mental Skills in Patients Who Received Gadolinium-based Contrast Media for Magnetic Resonance Examination Multiple Times Within 5 Years	PHASE4	RECRUITING	Guerbet	—	—
NCT04851119	Tegavivint for the Treatment of Recurrent or Refractory Solid Tumors, Including Lymphomas and Desmoid Tumors	PHASE1 / PHASE2	RECRUITING	Children's Oncology Group	—	Single country
NCT04282083	Protocol ITANET - Registry	N/A	RECRUITING	Italian Association Neuroendocrine Tumors	—	Single country
NCT07118176	Determining the Biodistribution of an Imaging Tracer (68Ga-FAPi-46) in Patients With Solid Tumors or Hematologic Cancers	PHASE1	RECRUITING	Jonsson Comprehensive Cancer Center	—	Phase 1 only Small N (<50) Single country
NCT01174121	Immunotherapy Using Tumor Infiltrating Lymphocytes for Patients With Metastatic Cancer	PHASE2	RECRUITING	National Cancer Institute (NCI)	—	Surrogate endpoint only Single country
NCT03452774	SYNERGY-AI: Artificial Intelligence Based Precision Oncology Clinical Trial Matching and Registry	N/A	RECRUITING	Massive Bio, Inc.	—	—
NCT03048266	Metabolomics and Genetic Diagnosing Pancreatic Neuroendocrine Tumors in MEN1 Patients	N/A	RECRUITING	M.D. Anderson Cancer Center	—	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 Everolimus monotherapy (advanced/progressive pNET G1/G2; RADIANT-3) (REG-EVEROLIMUS-MONO-PNET) 1/1 component drug(s) not on NSZU formulary	✓ registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Trial · NCT06016855 Surgical Debulking Prior to Peptide Receptor Radionuclide Therapy in Well Differentiated Gastroenteropancreatic Neuroendocrine Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06596915 Safety and Efficacy of BA1302 in Patients With Advanced Solid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03454035 Ulixertinib/Palbociclib in Patients With Advanced Pancreatic and Other Solid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04373564 Effect on Body Movement and Mental Skills in Patients Who Received Gadolinium-based Contrast Media for Magnetic Resonance Examination Multiple Times Within 5 Years No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04851119 Tegavivint for the Treatment of Recurrent or Refractory Solid Tumors, Including Lymphomas and Desmoid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04282083 Protocol ITANET - Registry No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07118176 Determining the Biodistribution of an Imaging Tracer (68Ga-FAPi-46) in Patients With Solid Tumors or Hematologic Cancers No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT01174121 Immunotherapy Using Tumor Infiltrating Lymphocytes for Patients With Metastatic Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03452774 SYNERGY-AI: Artificial Intelligence Based Precision Oncology Clinical Trial Matching and Registry No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03048266 Metabolomics and Genetic Diagnosing Pancreatic Neuroendocrine Tumors in MEN1 Patients 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: 2026-06-27.

plan_id: PLAN-COVERAGE-PNET-001-V1 | version: 1 | generated: 2026-06-27T09:41:00.727795+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.