OpenOnco · Treatment Plan

Treatment plan — Pancreatic neuroendocrine tumor

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

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.
ECOG ≥3 routinely excludes patients from cytotoxic intensification trials. Decision is rarely "no treatment" but rather "treatment proportional to the patient's reserve": prednisolone-only debulk for steroid-responsive disease (DLBCL…
RF-FITNESS-ECOG-POORSRC-NCCN-BCELL-2025SRC-ESMO-DLBCL-2024
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.
Reverted to draft: true pending second source (SRC-ESMO-NET-2024 or similar) per §6.1 two-reviewer quality gate. Currently only cites SRC-NCCN-NET-2025. WHO 2019 split G3 NETs into two categories: (1) Well-differentiated G3 NET: Ki67…
RF-NET-HIGH-GRADE-G3SRC-NCCN-NET-2025SRC-CLARINET-CAPLIN-2014

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-MEN4-CONFIRMED-CARRIER, 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: 2026-08-18.

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
NCT05086692	A Beta-only IL-2 ImmunoTherapY Study	PHASE1 / PHASE2	RECRUITING	Medicenna Therapeutics, Inc.	—	—
NCT04949282	Spanish Series of Patients Treated With the Radionuclide Lutetium177	N/A	RECRUITING	Sociedad Española de Medicina Nuclear e Imagen Molecular	—	Single country
NCT04706910	18F-DOPA II - PET Imaging Optimization	PHASE3	RECRUITING	University of Alberta	—	Single country
NCT06505395	A Trial to Assess Efficacy, Safety, Pharmacokinetics of Octreotide Subcutaneous Injection in Patients With Gastroentero-pancreatic Neuroendocrine Tumor (GEP-NET)	PHASE2	RECRUITING	CSPC ZhongQi Pharmaceutical Technology Co., Ltd.	—	Surrogate endpoint only Single country
NCT04074135	Natural History and Management of Von Hippel-Lindau (VHL) Associated Pancreatic Neuroendocrine Tumors	PHASE2	RECRUITING	National Cancer Institute (NCI)	—	Single country
NCT06893783	Efficacy and Safety Evaluation of Tarlatamab in Advanced Extrapulmonary Neuroendocrine Carcinoma Patients	PHASE2	RECRUITING	Inkeun Park	—	Surrogate endpoint only Single country
NCT05969860	At-Home Cancer Directed Therapy Versus in Clinic for the Treatment of Patients With Advanced Cancer	PHASE2	RECRUITING	Mayo Clinic	—	Single country
NCT06943755	Zanzalintinib Versus Everolimus in Participants With Locally Advanced or Metastatic Neuroendocrine Tumors	PHASE2 / PHASE3	RECRUITING	Exelixis	—	Surrogate endpoint only
NCT01416714	Tissue Procurement for Gastric Cancer, Gastrointestinal Stromal Tumors (GIST), Esophageal Cancer, Pancreas Cancer, Hepatocellular Cancer, Biliary Cancer, Neuroendocrine, Peritoneal Mesothelioma, Anal Cancer and Colorectal Cancer in Patients Undergoing Surgery or Biopsy	N/A	RECRUITING	University of Chicago	—	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 · NCT05086692 A Beta-only IL-2 ImmunoTherapY Study No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04949282 Spanish Series of Patients Treated With the Radionuclide Lutetium177 No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04706910 18F-DOPA II - PET Imaging Optimization No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06505395 A Trial to Assess Efficacy, Safety, Pharmacokinetics of Octreotide Subcutaneous Injection in Patients With Gastroentero-pancreatic Neuroendocrine Tumor (GEP-NET) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04074135 Natural History and Management of Von Hippel-Lindau (VHL) Associated Pancreatic Neuroendocrine Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06893783 Efficacy and Safety Evaluation of Tarlatamab in Advanced Extrapulmonary Neuroendocrine Carcinoma Patients No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05969860 At-Home Cancer Directed Therapy Versus in Clinic for the Treatment of Patients With Advanced Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06943755 Zanzalintinib Versus Everolimus in Participants With Locally Advanced or Metastatic Neuroendocrine Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT01416714 Tissue Procurement for Gastric Cancer, Gastrointestinal Stromal Tumors (GIST), Esophageal Cancer, Pancreas Cancer, Hepatocellular Cancer, Biliary Cancer, Neuroendocrine, Peritoneal Mesothelioma, Anal Cancer and Colorectal Cancer in Patients Undergoing Surgery or Biopsy 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-PNET-001-V1 | version: 1 | generated: 2026-08-18T07:59:48.397549+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.