OpenOnco · Treatment Plan

Treatment plan — Endometrial carcinoma

PLAN-SHOWCASE-ENDOMETRIAL-DMMR-001-V1 · v1 · 2026-05-13

Patient

SHOWCASE-ENDOMETRIAL-DMMR-001 · Algorithm: ALGO-ENDOMETRIAL-ADVANCED-1L

DiagnosisEndometrial carcinoma

MOH / ICD-10C54

ICD-O-38380/3; C54.1

StageIVB

Histologyendometrioid adenocarcinoma

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-DMMR-IHC	MSH2 germline loss-of-function (dMMR / MSI-H)	IA	Trial or research option SRC-CIVIC: Level C (Supports, Oncogenicity)	MSH2 germline loss-of-function in endometrial produces dMMR/MSI-H phenotype. Pan-tumor MSI-H ICI eligibility (pembrolizumab per KEYNOTE-158, dostarlimab per GARNET) supersedes tumor-specific lines via tissue-agnostic FDA approval. Advanced/recurrent dMMR endometrial: dostarlimab + carbo/paclitaxel 1L (RUBY) and pembrolizumab + carbo/paclitaxel (NRG-GY018) doubled PFS. Dostarlimab/pembrolizumab monotherapy in 2L+. Adjuvant ICI in early-stage dMMR under study.	dostarlimab + carbo/paclitaxel (1L advanced dMMR, RUBY) pembrolizumab + carbo/paclitaxel (1L advanced, NRG-GY018) dostarlimab monotherapy (2L+ dMMR, GARNET) pembrolizumab monotherapy (pan-tumor MSI-H)	SRC-NCCN-UTERINE-2025 SRC-ESGO-ENDOMETRIAL-2025
BIO-MSI-STATUS	MSI-H	IA	SRC-NCCN-UTERINE-2025 SRC-ESMO-ENDOMETRIAL-2022 Evidence cited from clinical guidelines; per-source evidence levels not yet structured. See Phase-2-of-CIViC-pivot for re-cite roadmap.	MSI-H/dMMR endometrial cancer (~25-30% of advanced cases) qualifies for ICI-based regimens. Dostarlimab + carboplatin + paclitaxel 1L (RUBY trial; mOS NR vs 36.7 mo, HR 0.64 in dMMR/MSI-H subgroup; FDA-approved 2023). Pembrolizumab + carboplatin + paclitaxel 1L (KEYNOTE-868/NRG-GY018; FDA-approved 2023 for dMMR/MSI-H). Also pembrolizumab monotherapy 2L+ for MSI-H/dMMR endometrial (KEYNOTE-158; FDA-approved 2017 tumor-agnostically). MSI/MMR testing mandatory at diagnosis of advanced/recurrent endometrial cancer per NCCN/ESMO. Indication selection enforced by algorithm layer (IND-ENDOMETRIAL-DMMR); this BMA surfaces ESCAT context only.	dostarlimab + carboplatin + paclitaxel (dMMR/MSI-H 1L per SRC-NCCN-UTERINE-2025) pembrolizumab + carboplatin + paclitaxel (dMMR/MSI-H 1L per SRC-NCCN-UTERINE-2025) pembrolizumab monotherapy (MSI-H 2L+ per SRC-ESMO-ENDOMETRIAL-2022)	SRC-NCCN-UTERINE-2025 SRC-ESMO-ENDOMETRIAL-2022

⚠️ Not included in plan

Biomarker	Status
MSH2	Not in KB — ask clinician to verify
POLE	Excluded (negative)
TP53	Not in KB — ask clinician to verify

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-ENDOMETRIAL-ADVANCED-1L-PEMBRO-CHEMO

Regimen

Pembrolizumab + carbo + paclitaxel (endometrial advanced 1L)

Drugs + NSZU

Pembrolizumab (DRUG-PEMBROLIZUMAB) 200 mg IV q3w · Continuous up to 2 years · IV ⚠ NSZU — not for this indication
Carboplatin (DRUG-CARBOPLATIN) AUC 5 IV · Day 1 x 6 cycles · IV ⚠ NSZU — not for this indication
Paclitaxel (DRUG-PACLITAXEL) 175 mg/m² IV · Day 1 x 6 cycles · IV ⚠ NSZU — not for this indication

Reason

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

Other current-line alternatives (1 tracks)

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

Aggressive plan

Indication

IND-ENDOMETRIAL-ADVANCED-1L-DOSTARLIMAB-CHEMO

Regimen

Dostarlimab + carbo + paclitaxel (endometrial advanced 1L dMMR)

Drugs + NSZU

Dostarlimab (DRUG-DOSTARLIMAB) 500 mg IV q3w → 1000 mg q6w maintenance · With chemo cycles 1-6 + maintenance up to 3 years · IV ✗ Not registered in UA
Carboplatin (DRUG-CARBOPLATIN) AUC 5 IV · Day 1 x 6 cycles · IV ⚠ NSZU — not for this indication
Paclitaxel (DRUG-PACLITAXEL) 175 mg/m² IV · Day 1 x 6 cycles · 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-ER-PR-IHC	ER + PR immunohistochemistry on tumor	Critical	—	CSD Lab ✓ (code TBC)	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). RF-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISK

CONTRA-AGGRESSIVE

Hard contraindications to escalation

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Pembrolizumab + carbo + paclitaxel (endometrial advanced 1L)

21-day cycles × Chemo x 6; pembro maintenance up to 2 years

Aggressive plan

Induction · Dostarlimab + carbo + paclitaxel (endometrial advanced 1L dMMR)

21-day cycles × Chemo x 6; dostarlimab maintenance up to 3 years

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 (2 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.

Skills (recommended) — for consideration (1)

Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.

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-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISK, RF-ENDOMETRIAL-FIT-FOR-LENVATINIB-COMBO, RF-ENDOMETRIAL-FRAILTY-AGE, RF-ENDOMETRIAL-HIGH-RISK-BIOLOGY, RF-ENDOMETRIAL-INFECTION-SCREENING, RF-ENDOMETRIAL-ORGAN-DYSFUNCTION, RF-ENDOMETRIAL-TRANSFORMATION-PROGRESSION, RF-POLE-POLD1-ENDOMETRIAL-LOW-RISK

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-ESMO-ENDOMETRIAL-2022: ESMO-ESGO-ESTRO Endometrial Consensus (2022)
SRC-GY018-MAKKER-2022: Lenvatinib plus Pembrolizumab for Advanced Endometrial Cancer ()
SRC-NCCN-UTERINE-2025: NCCN Uterine Neoplasms (2025.v2)
SRC-RUBY-MIRZA-2023: Dostarlimab for Primary Advanced or Recurrent Endometrial Cancer ()

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: 2026-05-13.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT06738966	A Study of BL0175 Injection in Postmenopausal Female Adults With HR-positive, Locally Advanced or Metastatic Cancer	PHASE1	RECRUITING	Shanghai Best-Link Bioscience, LLC	—	Phase 1 only Small N (<50) Single country
NCT07166094	Study to Assess the Efficacy and Safety of Rina-S Compared to Treatment of Investigator's Choice in Participants With Endometrial Cancer	PHASE3	RECRUITING	Genmab	—	—
NCT06538337	Hypofractionated External Beam Radiotherapy With Adaptive Planning for Endometrial and Cervical Cancers	NA	RECRUITING	Jonsson Comprehensive Cancer Center	—	Single country
NCT05974995	Robotic-assisted Versus Conventional Laparoscopic Surgery in Obese Patients With Early Endometrial Cancer	NA	RECRUITING	Fondazione Policlinico Universitario Agostino Gemelli IRCCS	—	Single country
NCT06278857	SATELLITE Study (feaSibility sAfeTy Efficacy dostarLimab earLy-stage defIcient endomeTrial cancEr)	PHASE2	RECRUITING	Queensland Centre for Gynaecological Cancer	—	Small N (<50) Single country
NCT06943521	A Study of MT-4561 in Patients With Various Advanced Solid Tumors	PHASE1 / PHASE2	RECRUITING	Tanabe Pharma America, Inc.	—	Small N (<50)
NCT03422198	Short Course Vaginal Cuff Brachytherapy in Treating Participants With Stage I-II Endometrial Cancer	PHASE3	RECRUITING	University of Utah	—	Single country
NCT01174121	Immunotherapy Using Tumor Infiltrating Lymphocytes for Patients With Metastatic Cancer	PHASE2	RECRUITING	National Cancer Institute (NCI)	—	Surrogate endpoint only Single country
NCT06253494	Pembrolizumab, Lenvatinib and IL-15 Superagonist N-803 in Combination With HER2 Targeting Autologous Dendritic Cell (AdHER2DC) Vaccine in Participants With Advanced or Metastatic Endometrial Cancer	PHASE1 / PHASE2	RECRUITING	National Cancer Institute (NCI)	—	Single country
NCT05912972	Development and Management of Registry in Patients With Gynecologic Cancer in Korea	N/A	RECRUITING	Asan Medical 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 Pembrolizumab + carbo + paclitaxel (endometrial advanced 1L) (REG-PEMBRO-CARBO-PACLI-ENDOM)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Aggressive plan Dostarlimab + carbo + paclitaxel (endometrial advanced 1L dMMR) (REG-DOSTARLIMAB-CARBO-PACLI-ENDOM) 1/3 component drug(s) not registered in Ukraine +1	✗ not registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Trial · NCT06738966 A Study of BL0175 Injection in Postmenopausal Female Adults With HR-positive, Locally Advanced or Metastatic Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07166094 Study to Assess the Efficacy and Safety of Rina-S Compared to Treatment of Investigator's Choice in Participants With Endometrial Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06538337 Hypofractionated External Beam Radiotherapy With Adaptive Planning for Endometrial and Cervical Cancers No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05974995 Robotic-assisted Versus Conventional Laparoscopic Surgery in Obese Patients With Early Endometrial Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06278857 SATELLITE Study (feaSibility sAfeTy Efficacy dostarLimab earLy-stage defIcient endomeTrial cancEr) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06943521 A Study of MT-4561 in Patients With Various Advanced Solid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03422198 Short Course Vaginal Cuff Brachytherapy in Treating Participants With Stage I-II Endometrial Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT01174121 Immunotherapy Using Tumor Infiltrating Lymphocytes for Patients With Metastatic Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06253494 Pembrolizumab, Lenvatinib and IL-15 Superagonist N-803 in Combination With HER2 Targeting Autologous Dendritic Cell (AdHER2DC) Vaccine in Participants With Advanced or Metastatic Endometrial Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05912972 Development and Management of Registry in Patients With Gynecologic Cancer in Korea 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: 2026-05-13.

plan_id: PLAN-SHOWCASE-ENDOMETRIAL-DMMR-001-V1 | version: 1 | generated: 2026-05-13T10:01:50.955263+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.