OpenOnco · Treatment Plan

Treatment plan — Testicular germ cell tumor

PLAN-COVERAGE-GCT-001-V1 · v1 · 2026-05-12

Patient

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

DiagnosisTesticular germ cell tumor

MOH / ICD-10C62.9

ICD-O-39061/3; C62.0, C62.1, C62.9

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-GCT-METASTATIC-1L-BEP

Regimen

BEP (bleomycin + etoposide + cisplatin, germ cell tumor)

Drugs + NSZU

Bleomycin (DRUG-BLEOMYCIN) 30 IU IV push over 10 min (or 30 IU in 100 mL NS over 30 min) · Days 2, 9, 16 of each 21-day cycle (once weekly per cycle) · IV ⚠ NSZU — not for this indication
Etoposide (DRUG-ETOPOSIDE) 100 mg/m²/day IV over 60 min · Days 1-5 of each 21-day cycle · IV ⚠ NSZU — not for this indication
Cisplatin (DRUG-CISPLATIN) 20 mg/m²/day IV over 60 min with aggressive hydration · Days 1-5 of each 21-day cycle (total 100 mg/m² per cycle) · IV ⚠ NSZU — not for this indication

Reason

Provisional current-line default from ALGO-GCT-METASTATIC-1L: step 1 did not select a treatment branch. Radical inguinal orchiectomy must be performed before systemic chemotherapy. (1) Provides histological diagnosis — seminoma vs NSGCT determines treatment; (2) Removes primary tumor; (3) Allows accurate post-orchiectomy marker trajectory assessment. EXCEPTION: rapidly progressive...

Other current-line alternatives (1 tracks)

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

Standard plan

Indication

IND-GCT-METASTATIC-1L-EP

Regimen

EP (etoposide + cisplatin, germ cell tumor)

Drugs + NSZU

Etoposide (DRUG-ETOPOSIDE) 100 mg/m²/day IV over 60 min · Days 1-5 of each 21-day cycle · IV ⚠ NSZU — not for this indication
Cisplatin (DRUG-CISPLATIN) 20 mg/m²/day IV over 60 min with aggressive hydration · Days 1-5 of each 21-day cycle (total 100 mg/m² per cycle) · 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-AFP	AFP serum	Critical	lab	CSD Lab: B001	all tracks
TEST-BETA-HCG	Beta-hCG	Critical	lab	—	all tracks
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-LDH	Lactate Dehydrogenase	Critical	lab	—	all tracks
TEST-LFT	Liver Function Tests (ALT, AST, bilirubin, ALP, GGT, albumin)	Critical	lab	—	all tracks
TEST-AUDIOMETRY	Audiometry	Standard	clinical_assessment	—	all tracks
TEST-BRAIN-MRI-CONTRAST	Brain MRI with contrast	Standard	—	—	desired (standard)
TEST-CT-CAP	CT chest/abdomen/pelvis	Standard	imaging	—	all tracks
TEST-PET-CT	FDG PET/CT (whole body)	Standard	imaging	—	desired (standard)
TEST-PFT-SPIROMETRY-DLCO	Pulmonary function tests with DLCO	Standard	clinical_assessment	—	all tracks

What NOT to do

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

Standard plan (IND-GCT-METASTATIC-1L-BEP)

НІКОЛИ не давати FiO₂ >30% пацієнтам під час або після BEP — O₂ + блеоміцин = фатальний легеневий фіброз; попередити анестезіолога
Не пропускати DLCO базово і перед кожним циклом при 4-циклових протоколах — припинити блеоміцин при падінno DLCO >25%
Не знижувати дози цисплатину або етопозиду заради токсичності без G-КСФ ескалації — ГКП є курабельним; дозова інтенсивnoсть критична
Не починати BEP до орхіектомії (крім рідких випадків з загрозою для життя від поширеного захворювання)
Не ігнорувати зростання маркерів (АФП/ХГЛ) після 1-2 циклів BEP — може свідчити про рефрактерне захворювання; проконсультуватись з GCT-спеціалістом
Не використовувати карбоплатин замість цисплатину при нормальnoй функції нирок — карбоплатин НИЖЧА ефективnoсть при поганому/середньому ризику GCT (лише при CrCl <30 або непереносимості)

Standard plan (IND-GCT-METASTATIC-1L-EP)

Не зменшувати до 3 циклів EP (лише 3 цикли BEP є еквівалентними при хорошому ризику — скорочення EP не підтверджено)
Не додавати блеоміцин — ця схема для пацієнтів, яким ПРОТИПОКАЗАНИЙ блеоміцин
Не знижувати дози цисплатину або етопозиду без G-КСФ ескалації — ГКП є курабельним захворюванням
Аудіограма базово та після завершення — цисплатин-індукована ототоксичnoсть

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · BEP (bleomycin + etoposide + cisplatin, germ cell tumor)

21-day cycles × 3 cycles (good risk per IGCCC) OR 4 cycles (intermediate/poor risk per IGCCC)

Standard plan

Induction · EP (etoposide + cisplatin, germ cell tumor)

21-day cycles × 4 cycles for good-risk (equivalence to BEP ×3); 4 cycles for intermediate/poor risk

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-IGCCC-1997: International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers ()
SRC-NCCN-TESTICULAR-2025: NCCN Clinical Practice Guidelines — Testicular Cancer (2025.v2)

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
NCT03382158	International PPB/DICER1 Registry	N/A	RECRUITING	Children's Hospitals and Clinics of Minnesota	—	Single country
NCT05670938	Follow-up After Surgery for Testicular Cancer	N/A	RECRUITING	Erasmus Medical Center	—	Single country
NCT07106827	A Study of GV20-0251 in Advanced or Refractory Solid Tumors	PHASE1	RECRUITING	West China Hospital	—	Phase 1 only Small N (<50) Single country
NCT03067181	Active Surveillance, Bleomycin, Etoposide, Carboplatin or Cisplatin in Treating Pediatric and Adult Patients With Germ Cell Tumors	PHASE3	RECRUITING	Children's Oncology Group	—	—
NCT06041503	Enfortumab Vedotin With or Without Pembrolizumab in Rare Genitourinary Tumors (E-VIRTUE)	PHASE2	RECRUITING	National Cancer Institute (NCI)	—	Surrogate endpoint only Single country
NCT07138222	IMmune checkPoint Inhibitor Related gonAdal toxiCiTy in Premenopausal Women and Men With Melanoma	N/A	RECRUITING	Peter MacCallum Cancer Centre, Australia	—	Single country
NCT07453082	A Prospective Study to Evaluate miRNA371 and Outcomes in Patients With Newly Diagnosed Germ Cell Tumors	N/A	RECRUITING	Fondazione del Piemonte per l'Oncologia	—	Single country
NCT07259304	Social Health, Activity Behaviors, and Quality of Life Among Young Adult Cancer Survivors	N/A	RECRUITING	University of Southern California	—	Single country
NCT06133543	Robot-assisted ICG-guided Sentinel Node Biopsy in Testicular Cancer	NA	RECRUITING	Heinrich-Heine University, Duesseldorf	—	Small N (<50) Single country
NCT02099734	Germ Cell Tumor and Testicular Tumor DNA Registry	N/A	RECRUITING	Memorial Sloan Kettering 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 BEP (bleomycin + etoposide + cisplatin, germ cell tumor) (REG-BEP-GCT)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Standard plan EP (etoposide + cisplatin, germ cell tumor) (REG-EP-GCT)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT03382158 International PPB/DICER1 Registry No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05670938 Follow-up After Surgery for Testicular Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07106827 A Study of GV20-0251 in Advanced or Refractory Solid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03067181 Active Surveillance, Bleomycin, Etoposide, Carboplatin or Cisplatin in Treating Pediatric and Adult Patients With Germ Cell Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06041503 Enfortumab Vedotin With or Without Pembrolizumab in Rare Genitourinary Tumors (E-VIRTUE) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07138222 IMmune checkPoint Inhibitor Related gonAdal toxiCiTy in Premenopausal Women and Men With Melanoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07453082 A Prospective Study to Evaluate miRNA371 and Outcomes in Patients With Newly Diagnosed Germ Cell Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07259304 Social Health, Activity Behaviors, and Quality of Life Among Young Adult Cancer Survivors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06133543 Robot-assisted ICG-guided Sentinel Node Biopsy in Testicular Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT02099734 Germ Cell Tumor and Testicular Tumor DNA Registry 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-GCT-001-V1 | version: 1 | generated: 2026-05-12T18:41:26.039043+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.