OpenOnco · Treatment Plan

Treatment plan — Ovarian carcinoma

PLAN-OVAR-HRD-001-V1 · v1 · 2026-07-26

Patient

OVAR-HRD-001 · Algorithm: ALGO-OVARIAN-ADVANCED-1L

DiagnosisOvarian carcinoma

MOH / ICD-10C56

ICD-O-38441/3; C56, C57.0, C48.1

StageFIGO IIIC

Histologyhigh-grade serous

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
BIO-HRD-STATUS	HRD-positive — BRCA1/2 mutation OR genomic instability score (GIS) above validated threshold (Myriad MyChoice ≥42 or equivalent FoundationOne CDx HRD signature); ~50% of high-grade serous ovarian carcinoma	IA	SRC-NCCN-OVARIAN-2025 SRC-ESMO-OVARIAN-2024 Evidence cited from clinical guidelines; per-source evidence levels not yet structured. See Phase-2-of-CIViC-pivot for re-cite roadmap.	HRD-positive high-grade serous ovarian carcinoma (~50% — encompassing BRCA1/2-mutated and BRCA-WT/HRD+): PARP inhibitor maintenance after platinum response is FDA-approved 1L. Olaparib monotherapy maintenance for BRCA1/2-mutated newly-diagnosed advanced ovarian after CR/PR to platinum (SOLO-1 Moore NEJM 2018 — mPFS not reached vs 13.8 mo, HR 0.30) per SRC-NCCN-OVARIAN-2025, SRC-ESMO-OVARIAN-2024. Olaparib + bevacizumab maintenance for HRD-positive (BRCA-mut OR HRD-genomic) post-1L platinum + bevacizumab (PAOLA-1 Ray-Coquard NEJM 2019 — HRD subgroup mPFS 37 vs 17 mo, HR 0.33). Niraparib monotherapy maintenance is approved for all-comers (PRIMA Gonzalez-Martin NEJM 2019), with the strongest benefit in HRD-positive subgroup.	olaparib monotherapy maintenance (1L BRCA1/2-mut per SRC-NCCN-OVARIAN-2025, SRC-ESMO-OVARIAN-2024) olaparib + bevacizumab maintenance (1L HRD-positive non-BRCA per SRC-NCCN-OVARIAN-2025) niraparib monotherapy maintenance (1L per SRC-NCCN-OVARIAN-2025, all-comers benefit, HRD-positive strongest) rucaparib monotherapy (2L maintenance / treatment per SRC-NCCN-OVARIAN-2025)	SRC-NCCN-OVARIAN-2025 SRC-ESMO-OVARIAN-2024

⚠️ Not included in plan

Biomarker	Status
BIO-BRCA1-BRCA2-GERMLINE	BIO definition in KB; no ESCAT BMA entry — verify with clinician

Primary current-line option

Aggressive plan

★ DEFAULT

Indication

IND-OVARIAN-ADVANCED-1L-CARBO-PACLI-HRD-OLAP

Regimen

Carboplatin + Paclitaxel (ovarian 3-weekly)

Drugs + NSZU

Carboplatin (DRUG-CARBOPLATIN) AUC 5-6 · IV day 1 every 21d · IV ✓ NSZU covered
Paclitaxel (DRUG-PACLITAXEL) 175 mg/m² · IV day 1 every 21d · IV ✓ NSZU covered

Reason

Primary current-line option selected by ALGO-OVARIAN-ADVANCED-1L at step 3; branch-driving red flag: RF-OVARIAN-BRCA-MUT-ACTIONABLE.

Other current-line alternatives (1 tracks)

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

Aggressive plan

Indication

IND-OVARIAN-MAINTENANCE-OLAPARIB

Regimen

Olaparib maintenance (HRD+ ovarian post-platinum response)

Drugs + NSZU

Olaparib (DRUG-OLAPARIB) 300 mg PO BID continuous · Continuous · PO ✓ NSZU covered

Reason

Current-line alternative presented for HCP consideration

Why this branch was chosen

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

Step 3 → branch IND-OVARIAN-ADVANCED-1L-CARBO-PACLI-HRD-OLAP

RF-OVARIAN-BRCA-MUT-ACTIONABLE ★ winner: BRCA1 or BRCA2 pathogenic variant (germline OR somatic) in high-grade serous ovarian carcinoma — ~20-25% prevalence (15% germline + ~7% somatic). Olaparib maintenance after platinum-based 1L (SOLO-1 — mPFS 56.0 vs 13.8 mo BRCA-mut) is treatment-defining; rucaparib + niraparib alternatives. SOLO-2 — 2L+ relapse maintenance. SRC-NCCN-OVARIAN-2025SRC-ESMO-OVARIAN-2024SRC-SOLO1-MOORE-2018SRC-SOLO2-PUJADE-LAURAINE-2017

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

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

BRCA1 or BRCA2 pathogenic variant (germline OR somatic) in high-grade serous ovarian carcinoma — ~20-25% prevalence (15% germline + ~7% somatic). Olaparib maintenance after platinum-based 1L (SOLO-1 — mPFS 56.0 vs 13.8 mo BRCA-mut) is treatment-defining; rucaparib + niraparib alternatives. SOLO-2 — 2L+ relapse maintenance.
Tumor-tissue testing identifies somatic BRCA missed by germline-only testing — both germline (blood) AND tumor BRCA testing recommended at diagnosis for all newly diagnosed advanced ovarian. Germline finding triggers cascade testing of…
RF-OVARIAN-BRCA-MUT-ACTIONABLESRC-NCCN-OVARIAN-2025SRC-ESMO-OVARIAN-2024SRC-SOLO1-MOORE-2018
HRD-positive (BRCA1/2 mutation OR Genomic Instability Score ≥42) high-grade serous ovarian carcinoma. Treatment-defining for PARPi maintenance after platinum-based induction. Olaparib (SOLO-1 BRCA-only, PAOLA-1 with bev) + niraparib (PRIMA all-comer) substantially improve PFS in HRD-positive subset.
HRD testing on FFPE tumor + paired germline. Reflex BRCA → if WT, proceed to GIS scoring. SOLO-1: BRCA-mut maintenance olaparib mPFS 56 vs 14 mo. PAOLA-1: HRD-positive (BRCA-mut OR GIS+) bev+olap mPFS 37 vs 22 mo. PRIMA: niraparib…
RF-OVARIAN-HRD-ACTIONABILITYSRC-NCCN-OVARIAN-2025SRC-ESMO-OVARIAN-2024
Homologous Recombination Deficiency (HRD)-positive high-grade serous ovarian carcinoma (BRCA1/2 mutation OR Genomic Instability Score ≥42). PARPi maintenance after platinum-based induction is treatment-defining: niraparib (PRIMA — mPFS 21.9 vs 10.4 mo HRD-pos), olaparib + bevacizumab (PAOLA-1 — mPFS 37.2 vs 17.7 mo HRD-pos).
HRD assays: Myriad myChoice CDx (companion for olaparib + bev, niraparib), FoundationOne CDx HRD. GIS captures BRCAness (LOH + TAI + LST signatures) in tumors WT for BRCA1/2. HRD-negative HGSC has minimal PARPi maintenance benefit (PRIMA…
RF-OVARIAN-HRD-POSITIVE-ACTIONABLESRC-NCCN-OVARIAN-2025SRC-ESMO-OVARIAN-2024SRC-PRIMA-GONZALEZ-MARTIN-2019

CONTRA-AGGRESSIVE

Hard contraindications to escalation

What NOT to do

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

Aggressive plan (IND-OVARIAN-ADVANCED-1L-CARBO-PACLI-HRD-OLAP)

Do NOT skip HRD testing — defines maintenance choice (PARPi-only HRD+; niraparib-all-comer if HRD-negative weak benefit)
Do NOT start olaparib without confirmed CR/PR to platinum induction
Do NOT continue olaparib through Grade 3 anemia without dose reduction

Aggressive plan (IND-OVARIAN-MAINTENANCE-OLAPARIB)

Do NOT start without confirmed CR/PR to platinum
Do NOT continue past 2 years for non-BRCA HRD+ unless still benefiting (label allows ≤24 mo)
Do NOT skip pre-treatment counseling on long-term MDS/AML risk

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Aggressive plan

Induction · Carboplatin + Paclitaxel (ovarian 3-weekly)

21-day cycles × 6 cycles (per GOG-218 / ICON-7 induction); subsequent maintenance per HRD/biomarker stratification

MDT brief

Discussion questions (2, 1 blocking)

BLOCKING OQ-HBV-SEROLOGY
Has HBV serology (HBsAg, anti-HBc total) been done? Status must be known before starting anti-CD20 therapy.
Anti-CD20 without HBV prophylaxis in HBsAg+/anti-HBc+ patients carries significant reactivation risk (CI-HBV-NO-PROPHYLAXIS).
→ infectious_disease_hepatology
OQ-LDH-CURRENT
What is the current LDH? Marker of tumor burden and transformation.
LDH is part of the prognostic indices of indolent lymphomas.
→ hematologist

MDT talk tree (4 steps)

#	Owner	Topic	Action
1	infectious_disease_hepatology	Infection / hepatic safety BLOCKING	Has HBV serology (HBsAg, anti-HBc total) been done? Status must be known before starting anti-CD20 therapy.
2	hematologist	Staging / disease burden	What is the current LDH? Marker of tumor burden and transformation.
3	clinical_pharmacist	Specialist review	Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
4	molecular_geneticist	Specialist review	Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.

Skills (recommended) — for consideration (2)

Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
Molecular geneticist / molecular oncologist recommended
Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.

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-BARD1-CONFIRMED-CARRIER, RF-BARD1-FAMILY-HISTORY-SUSPICION, RF-BRCA-CONFIRMED-CARRIER, RF-BRCA-HBOC-FAMILY-HISTORY-SUSPICION, RF-BREAST-OVARIAN-HRD-ASSAY-DISTINCTION, RF-BRIP1-CONFIRMED-CARRIER, RF-BRIP1-FAMILY-HISTORY-SUSPICION, RF-CASCADE-BRCA-FDR-POSITIVE, RF-CASCADE-LYNCH-FDR-POSITIVE, RF-DICER1-CONFIRMED-CARRIER, RF-LYNCH-CONFIRMED-CARRIER, RF-LYNCH-FAMILY-HISTORY-SUSPICION, RF-OCC-ASBESTOS-MALIGNANCY-PREVENTION, RF-OVARIAN-BRCA-MUT-ACTIONABLE, RF-OVARIAN-FRA-HIGH-ACTIONABLE, RF-OVARIAN-FRAILTY-AGE, RF-OVARIAN-HRD-POSITIVE-ACTIONABLE, RF-OVARIAN-INFECTION-SCREENING, RF-OVARIAN-PERIOPERATIVE-VTE, RF-OVARIAN-PLATINUM-RESISTANT, RF-OVARIAN-PLATINUM-SENSITIVE, RF-OVARIAN-SUBOPTIMAL-DEBULKING, RF-OVARIAN-TRANSFORMATION-PROGRESSION, RF-PALB2-CONFIRMED-CARRIER, RF-PALB2-FAMILY-HISTORY-SUSPICION, RF-PAN-BRCA-SOMATIC-PARPI-CANDIDATE, RF-PEUTZ-JEGHERS-CONFIRMED-CARRIER, RF-PEUTZ-JEGHERS-FAMILY-HISTORY-SUSPICION, RF-RAD51C-D-CONFIRMED-CARRIER, RF-RAD51C-D-FAMILY-HISTORY-SUSPICION, RF-REPRODUCTIVE-BREAST-ENDOMETRIAL-PREVENTION, RF-REPRODUCTIVE-ENDOMETRIOSIS-OVARIAN-PREVENTION, RF-REPRODUCTIVE-OCP-LONG-TERM

Technical MDT skill metadata (2/16 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-ESMO-OVARIAN-2024: ESMO Ovarian Cancer Clinical Practice Guideline (2024)
SRC-NCCN-OVARIAN-2025: NCCN Ovarian Cancer (v.2.2025)

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: 2026-07-26.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT06071286	SEQUENTIAL PROFILING OF TUMOR-DERIVED CIRCULATING CELL-FREE DNA (ctDNA) IN ADVANCED OVARIAN CANCER PATIENTS	NA	RECRUITING	Fondazione Policlinico Universitario Agostino Gemelli IRCCS	—	Small N (<50) Single country
NCT05961124	Alternative Dosing Of Niraparib To Decrease Dose Interruption In First Line Maintenance Treatment For Ovarian Cancer	PHASE2	RECRUITING	Sunnybrook Health Sciences Centre	—	Small N (<50) Single country
NCT05128825	A Study of Azenosertib (ZN-c3) in Subjects With Platinum-Resistant High-Grade Serous Ovarian, Fallopian Tube or Primary Peritoneal Cancer	PHASE2	RECRUITING	K-Group, Beta, Inc., a wholly owned subsidiary of Zentalis Pharmaceuticals, Inc	—	Surrogate endpoint only
NCT05080946	Using Aspirin to Improve Immunological Features of Ovarian Tumors	EARLY_PHASE1	RECRUITING	H. Lee Moffitt Cancer Center and Research Institute	—	Single country
NCT03878849	Investigation of the Anti-tumor Effect of 2X-121 in Patients With Recurrent, Advanced Ovarian Cancer	PHASE2	RECRUITING	Allarity Therapeutics	—	Small N (<50) Single country
NCT06687070	APG-2449 Monotherapy or in Combination With PLD in Patients With Platinum-resistant Recurrent OC or Advanced ST	PHASE1	RECRUITING	Ascentage Pharma Group Inc.	—	Phase 1 only Single country
NCT04284969	PROADAPT-ovary/EWOC-2	NA	RECRUITING	Hospices Civils de Lyon	—	Single country
NCT06690775	CATALINA-2: A Clinical Study of TORL-1-23 in Platinum-resistant Ovarian Cancer.	PHASE2	RECRUITING	TORL Biotherapeutics, LLC	—	—
NCT05659381	Heated Intraperitoneal Chemotherapy Followed by Niraparib for Ovarian, Primary Peritoneal and Fallopian Tube Cancer	PHASE3	RECRUITING	GOG Foundation	—	Surrogate endpoint only Single country
NCT06295965	Clonal Hematopoiesis and Therapy-Emergent Myeloid Neoplasms in Patients With Cancers, CHANCES Study	N/A	RECRUITING	University of Washington	—	Surrogate endpoint only 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
Aggressive plan Carboplatin + Paclitaxel (ovarian 3-weekly) (REG-CARBO-PACLI-OVARIAN)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Aggressive plan Olaparib maintenance (HRD+ ovarian post-platinum response) (REG-OLAPARIB-MAINT-OVARIAN)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT06071286 SEQUENTIAL PROFILING OF TUMOR-DERIVED CIRCULATING CELL-FREE DNA (ctDNA) IN ADVANCED OVARIAN CANCER PATIENTS No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05961124 Alternative Dosing Of Niraparib To Decrease Dose Interruption In First Line Maintenance Treatment For Ovarian Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05128825 A Study of Azenosertib (ZN-c3) in Subjects With Platinum-Resistant High-Grade Serous Ovarian, Fallopian Tube or Primary Peritoneal Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05080946 Using Aspirin to Improve Immunological Features of Ovarian Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03878849 Investigation of the Anti-tumor Effect of 2X-121 in Patients With Recurrent, Advanced Ovarian Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06687070 APG-2449 Monotherapy or in Combination With PLD in Patients With Platinum-resistant Recurrent OC or Advanced ST No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04284969 PROADAPT-ovary/EWOC-2 No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06690775 CATALINA-2: A Clinical Study of TORL-1-23 in Platinum-resistant Ovarian Cancer. No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05659381 Heated Intraperitoneal Chemotherapy Followed by Niraparib for Ovarian, Primary Peritoneal and Fallopian Tube Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06295965 Clonal Hematopoiesis and Therapy-Emergent Myeloid Neoplasms in Patients With Cancers, CHANCES Study 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: 2026-07-26.

plan_id: PLAN-OVAR-HRD-001-V1 | version: 1 | generated: 2026-07-26T09:28:48.274069+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.