OpenOnco · Treatment Plan

Treatment plan — Ovarian carcinoma

PLAN-OVAR-HRDNEG-001-V1 · v1 · 2026-06-27

Patient

OVAR-HRDNEG-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
No clinically actionable variants matched in this profile.

⚠️ Not included in plan

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

Primary current-line option

Standard plan

★ DEFAULT

Indication

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

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 6.

Other current-line alternatives (2 tracks)

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

Aggressive plan

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

Current-line alternative presented for HCP consideration

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

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	—	aggressive

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. RF-OVARIAN-BRCA-MUT-ACTIONABLE
Frailty profile precluding standard carbo+pacli + bev intensified induction in ovarian: ECOG ≥3, OR (age ≥75 + Charlson ≥3), OR composite (age ≥70 + ascites large-volume + albumin <3.0). Triggers carbo-mono OR weekly-dose-dense-pacli (less neuropathy / bone marrow). RF-OVARIAN-FRAILTY-AGE
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. RF-OVARIAN-HRD-ACTIONABILITY
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). RF-OVARIAN-HRD-POSITIVE-ACTIONABLE
Suboptimal primary cytoreductive surgery (residual disease ≥1 cm) or unresectable at presentation in advanced (FIGO III-IV) ovarian carcinoma. MDT-trigger for neoadjuvant chemo (NACT) → interval debulking surgery (IDS) pathway per CHORUS / EORTC55971 trials, rather than primary debulking. RF-OVARIAN-SUBOPTIMAL-DEBULKING

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-OVARIAN-ADVANCED-1L-CARBO-PACLI-HRD-NEG)

Do NOT use olaparib maintenance in HRD-negative — minimal benefit, MDS/AML risk
Do NOT initiate bev maintenance within 28 days of major surgery

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

Standard 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 (1, 0 blocking)

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 (3 steps)

#	Owner	Topic	Action
1	hematologist	Staging / disease burden	What is the current LDH? Marker of tumor burden and transformation.
2	clinical_pharmacist	Specialist review	Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
3	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-BRCA-CONFIRMED-CARRIER, RF-BRCA-HBOC-FAMILY-HISTORY-SUSPICION, RF-BREAST-OVARIAN-HRD-ASSAY-DISTINCTION, RF-LYNCH-CONFIRMED-CARRIER, RF-LYNCH-FAMILY-HISTORY-SUSPICION, RF-OCC-ASBESTOS-MALIGNANCY-PREVENTION, RF-OVARIAN-FRA-HIGH-ACTIONABLE, RF-OVARIAN-FRAILTY-AGE, 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-PAN-BRCA-SOMATIC-PARPI-CANDIDATE, RF-PEUTZ-JEGHERS-CONFIRMED-CARRIER, RF-PEUTZ-JEGHERS-FAMILY-HISTORY-SUSPICION, RF-REPRODUCTIVE-BREAST-ENDOMETRIAL-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: 2026-06-27.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT06019923	Study on the Dynamic Changes of Metabolic Biomarkers and Their Prognostic Relationship in Ovarian Cancer	N/A	RECRUITING	Women's Hospital School Of Medicine Zhejiang University	—	Surrogate endpoint only Single country
NCT07125209	Cognitive Impact of Neoadjuvant Chemotherapy for Ovarian Cancer	N/A	RECRUITING	University of Wisconsin, Madison	—	Small N (<50) Single country
NCT06307249	Precision Therapy for Solid Tumors: Synergistic CDK4/6 Inhibition and Anti-VEGF Targeting LncRNA	PHASE1	RECRUITING	Lebanese University	—	Phase 1 only Single country
NCT05920798	Vaccine Therapy Plus Pembrolizumab in Treating Advanced Ovarian, Fallopian Tube, or Primary Peritoneal Cavity Cancer	PHASE1 / PHASE2	RECRUITING	Mayo Clinic	—	Small N (<50) Surrogate endpoint only Single country
NCT07589543	Dual-Target CAR-NK Cells in Recurrent or Refractory Epithelial Ovarian Cancer	PHASE1 / PHASE2	RECRUITING	Beijing Biotech	—	Small N (<50) Single country
NCT07371104	Bioequivalence Study of DWZ2501 in Patients With Advanced BRCA-mutated High-grade Ovarian Cancer	PHASE1	RECRUITING	Daewoong Pharmaceutical Co. LTD.	—	Phase 1 only Small N (<50) Single country
NCT07432633	[18F]FPyQCP PET Imaging of Fibroblast Activation Protein in Selected Oncology Indications	PHASE1 / PHASE2	RECRUITING	Blue Earth Diagnostics	—	Single country
NCT03968406	Talazoparib and Radiation Therapy in Treating Patients With Locally Recurrent Gynecologic Cancers	PHASE1	RECRUITING	M.D. Anderson Cancer Center	—	Phase 1 only Small N (<50) Single country
NCT00722228	Autologous and Allogeneic Whole Cell Cancer Vaccine for Metastatic Tumors	PHASE1 / PHASE2	RECRUITING	Hadassah Medical Organization	—	Single country
NCT07498829	Population Based Germline Testing for Early Detection and Prevention of Cancer	NA	RECRUITING	Queen Mary University of London	—	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 Carboplatin + Paclitaxel (ovarian 3-weekly) (REG-CARBO-PACLI-OVARIAN)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
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 · NCT06019923 Study on the Dynamic Changes of Metabolic Biomarkers and Their Prognostic Relationship in Ovarian Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07125209 Cognitive Impact of Neoadjuvant Chemotherapy for Ovarian Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06307249 Precision Therapy for Solid Tumors: Synergistic CDK4/6 Inhibition and Anti-VEGF Targeting LncRNA No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05920798 Vaccine Therapy Plus Pembrolizumab in Treating Advanced Ovarian, Fallopian Tube, or Primary Peritoneal Cavity Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07589543 Dual-Target CAR-NK Cells in Recurrent or Refractory Epithelial Ovarian Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07371104 Bioequivalence Study of DWZ2501 in Patients With Advanced BRCA-mutated High-grade Ovarian Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07432633 [18F]FPyQCP PET Imaging of Fibroblast Activation Protein in Selected Oncology Indications No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03968406 Talazoparib and Radiation Therapy in Treating Patients With Locally Recurrent Gynecologic Cancers No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT00722228 Autologous and Allogeneic Whole Cell Cancer Vaccine for Metastatic Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07498829 Population Based Germline Testing for Early Detection and Prevention of Cancer 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-OVAR-HRDNEG-001-V1 | version: 1 | generated: 2026-06-27T09:41:02.811869+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.