OpenOnco · Treatment Plan

Treatment plan — Small cell lung cancer

PLAN-SCLC-ES-001-V1 · v1 · 2026-08-18

Patient

SCLC-ES-001 · Algorithm: ALGO-SCLC-1L

DiagnosisSmall cell lung cancer

MOH / ICD-10C34

ICD-O-38041/3; C34.9

Stageextensive

Histologysmall_cell_carcinoma

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-SCLC-EXTENSIVE-1L

Regimen

Etoposide-platinum + durvalumab (extensive SCLC, 1L)

Drugs + NSZU

Carboplatin (DRUG-CARBOPLATIN) AUC 5-6 IV · Day 1 of 21-day cycle x 4 cycles · IV ✓ NSZU covered
Etoposide (DRUG-ETOPOSIDE) 80-100 mg/m² IV · Days 1, 2, 3 of 21-day cycle x 4 cycles · IV ✓ NSZU covered
Durvalumab (DRUG-DURVALUMAB) 1500 mg IV q3 weeks (induction); 1500 mg q4 weeks (maintenance) · From cycle 1; maintenance until progression · IV ⚠ NSZU — not for this indication

Supportive care

SUP-G-CSF-PRIMARY-PROPHYLAXIS-PROSTATE

Reason

Primary current-line option selected by ALGO-SCLC-1L at step 1.

Other current-line alternatives (2 tracks)

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

Standard plan

Indication

IND-SCLC-LIMITED-1L

Regimen

Etoposide-platinum + concurrent thoracic RT (limited SCLC)

Drugs + NSZU

Cisplatin (DRUG-CISPLATIN) 75 mg/m² IV · Day 1 of 21-day cycle x 4 cycles · IV ✓ NSZU covered
Etoposide (DRUG-ETOPOSIDE) 100 mg/m² IV · Days 1, 2, 3 of 21-day cycle x 4 cycles · IV ✓ NSZU covered

Supportive care

SUP-G-CSF-PRIMARY-PROPHYLAXIS-PROSTATE

Reason

Current-line alternative presented for HCP consideration

Standard plan

Indication

IND-SCLC-LS-CONSOLIDATION-DURVA

Regimen

Durvalumab consolidation post-CRT (LS-SCLC)

Drugs + NSZU

Durvalumab (DRUG-DURVALUMAB) 1500 mg IV q4 weeks · Up to 24 months OR until progression / unacceptable toxicity · 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-CECT-CAP	CECT chest/abdomen/pelvis	Critical	imaging	—	all tracks
TEST-BRAIN-MRI-CONTRAST	Brain MRI with contrast	Standard	—	—	all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Patient with active or incompletely controlled pre-existing autoimmune or inflammatory disease (sarcoidosis, rheumatoid arthritis, IBD, SLE, autoimmune hepatitis, inflammatory myopathy, myasthenia gravis, or similar) is considered for immune checkpoint inhibitor (ICI) therapy — elevated risk of immune-related adverse events (irAE) flare or de-novo grade 3-4 irAE. Requires specialist (rheumatology / pulmonology / gastroenterology) pre-treatment review; prefer lower-irAE-burden backbone when options exist (pembrolizumab mono > ipilimumab+nivolumab).
Pre-existing autoimmune disease is present in ~10-15% of patients eligible for ICI therapy; historically excluded from pivotal trials. Real-world data (Abdel-Wahab 2018, 3557 pts) shows 55% experienced irAE flare and ~29% required…
RF-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISKSRC-SITC-ICI-IRAEMANAGEMENT-2021SRC-ESMO-ICI-TOXICITY-2022
Age ≥75 + ECOG ≥2 OR significant comorbidity — concurrent CRT (limited-stage) poorly tolerated; sequential CRT or single-agent palliative chemo considered.
Limited-stage SCLC + frailty: sequential CRT (chemo first, then RT) better tolerated than concurrent. Extensive-stage + frailty: EP + ICI feasible with G-CSF support.
RF-SCLC-FRAILTY-AGESRC-NCCN-SCLC-2025SRC-ESMO-SCLC-2021

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-SCLC-LS-CONSOLIDATION-DURVA)

Do NOT start durvalumab in patients with progression after CRT — ADRIATIC excluded such patients; benefit not shown
Do NOT start consolidation after SEQUENTIAL (not concurrent) CRT — ADRIATIC enrolled only cCRT; no evidence for sCRT
Do NOT continue through Grade ≥3 immune pneumonitis — permanent discontinuation; pneumonitis risk additive on prior thoracic RT
Do NOT delay start beyond 42 days post-CRT completion (protocol upper limit)

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Etoposide-platinum + durvalumab (extensive SCLC, 1L)

21-day cycles × EP × 4; durva maintenance until progression

Standard plan

Induction · Etoposide-platinum + concurrent thoracic RT (limited SCLC)

21-day cycles × 4-6 cycles concurrent with thoracic RT (60 Gy/30 fx once-daily OR 45 Gy/30 fx BID)

Standard plan

Induction · Durvalumab consolidation post-CRT (LS-SCLC)

28-day cycles × Up to 24 months consolidation post-concurrent CRT

MDT brief

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: 0/0 known (100%), 0 missing, 0 default-track gaps
Unevaluated RedFlags: RF-LIFESTYLE-TOBACCO-CANCER-PREVENTION, RF-OCC-ASBESTOS-MALIGNANCY-PREVENTION, RF-OCC-DIESEL-EXHAUST-PREVENTION, RF-OCC-FIREFIGHTER-PREVENTION, RF-OCC-IONIZING-RADIATION-PREVENTION, RF-OCC-PAH-PREVENTION, RF-OCC-PAINTERS-PREVENTION, RF-OCC-SILICA-PREVENTION, RF-RADON-MALIGNANCY-PREVENTION, RF-SCLC-BRAIN-METS-EMERGENCY, RF-SCLC-HIGH-RISK-BIOLOGY, RF-SCLC-INFECTION-SCREENING, RF-SCLC-ORGAN-DYSFUNCTION, RF-SCLC-PARANEOPLASTIC, RF-SCLC-SVC-SYNDROME

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-ADRIATIC-CHENG-2024: Durvalumab after Chemoradiotherapy in Limited-Stage Small-Cell Lung Cancer (2024)
SRC-ESMO-SCLC-2021: ESMO Clinical Practice Guideline on Small Cell Lung Cancer (2021)
SRC-NCCN-SCLC-2025: NCCN Clinical Practice Guidelines — Small Cell Lung Cancer (2025.v3)

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
NCT06709859	Afatinib Combined With Chemotherapy as Conversion Therapy in Unresectable EGFR Sensitive Mutation-positive Stage III NSCLC	PHASE2	RECRUITING	Shandong Public Health Clinical Center	—	Small N (<50) Single country
NCT06598527	Stereotactic Body Radiotherapy Followed by Tislelizumab Plus Platinum-based Chemotherapy Versus Tislelizumab Plus Platinum-based Chemotherapy as Neoadjuvant Therapy in Patients With Resectable Stage Ⅱ-Ⅲ Non-small Cell Lung Cancer: A Phase Ⅲ, Randomized, Multicenter, Prospective Study	PHASE3	RECRUITING	Yang Hong	—	Single country
NCT04510129	A Multicenter Cancer Biospecimen Collection Study	N/A	RECRUITING	Cofactor Genomics, Inc.	—	Single country
NCT05487391	A Study of QL1706 Combined With Platinum-containing Chemotherapy in Adjuvant Treatment of Stage II-IIIB Non-small Cell Lung Cancer After Complete Surgical Resection.	PHASE3	RECRUITING	Qilu Pharmaceutical Co., Ltd.	—	Surrogate endpoint only Single country
NCT06726720	UmbREALung - A Retrospective and Prospective, Observational, Real World Multi-cohort Study of Patients With Non-small Cell Lung Cancer (NSCLC) Initiating Approved Drugs Developed by AZ or as Part of an AZ Alliance	N/A	RECRUITING	AstraZeneca	—	Surrogate endpoint only Single country
NCT07166003	Efficacy of Neoadjuvant Immunotherapy in Patients With Lung Cancer	N/A	RECRUITING	Cancer Institute and Hospital, Chinese Academy of Medical Sciences	—	Single country
NCT06917573	PALACE: Cemiplimab Trial According to ctDNA Levels	PHASE2	RECRUITING	Fundación GECP	—	Single country
NCT06688422	Incentive Spirometry to Improve Outcomes in Lung Cancer Patients Undergoing Concurrent Chemotherapy and Radiation Therapy	NA	RECRUITING	The Cooper Health System	—	Single country
NCT06943820	AK129 Combination Therapy for Advanced Solid Tumors	PHASE1 / PHASE2	RECRUITING	Akeso	—	Surrogate endpoint only Single country
NCT07337096	Electro-Acupuncture in Lung cancER : EALER Study	NA	RECRUITING	Guangzhou University of Traditional Chinese Medicine	—	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
Standard plan Etoposide-platinum + durvalumab (extensive SCLC, 1L) (REG-EP-DURVA-SCLC)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Standard plan Etoposide-platinum + concurrent thoracic RT (limited SCLC) (REG-EP-CONCURRENT-RT-SCLC-LIMITED)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Standard plan Durvalumab consolidation post-CRT (LS-SCLC) (REG-DURVA-CONSOLIDATION-SCLC)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT06709859 Afatinib Combined With Chemotherapy as Conversion Therapy in Unresectable EGFR Sensitive Mutation-positive Stage III NSCLC No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06598527 Stereotactic Body Radiotherapy Followed by Tislelizumab Plus Platinum-based Chemotherapy Versus Tislelizumab Plus Platinum-based Chemotherapy as Neoadjuvant Therapy in Patients With Resectable Stage Ⅱ-Ⅲ Non-small Cell Lung Cancer: A Phase Ⅲ, Randomized, Multicenter, Prospective Study No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04510129 A Multicenter Cancer Biospecimen Collection Study No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05487391 A Study of QL1706 Combined With Platinum-containing Chemotherapy in Adjuvant Treatment of Stage II-IIIB Non-small Cell Lung Cancer After Complete Surgical Resection. No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06726720 UmbREALung - A Retrospective and Prospective, Observational, Real World Multi-cohort Study of Patients With Non-small Cell Lung Cancer (NSCLC) Initiating Approved Drugs Developed by AZ or as Part of an AZ Alliance No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07166003 Efficacy of Neoadjuvant Immunotherapy in Patients With Lung Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06917573 PALACE: Cemiplimab Trial According to ctDNA Levels No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06688422 Incentive Spirometry to Improve Outcomes in Lung Cancer Patients Undergoing Concurrent Chemotherapy and Radiation Therapy No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06943820 AK129 Combination Therapy for Advanced Solid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07337096 Electro-Acupuncture in Lung cancER : EALER 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: 2026-08-18.

plan_id: PLAN-SCLC-ES-001-V1 | version: 1 | generated: 2026-08-18T07:59:48.836750+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.