Synthetic educational example. Do not self-treat: a qualified treating physician must verify the sources, patient data, contraindications, and final plan.
Patient
SHOWCASE-OVARIAN-BRCA1-001 · Algorithm: ALGO-OVARIAN-2L
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 |
|---|
| ESCAT: clinical review pendingBIO-BRCA1-BRCA2-GERMLINE | BRCA1 germline pathogenic | IA | Molecular evidence option - SRC-CIVIC: Level A (Supports, Sensitivity/Response)
- SRC-CIVIC: Level B (Supports, Better Outcome)
Resistance or avoidance signal | BRCA1 germline pathogenic variants in advanced epithelial ovarian carcinoma (incl. fallopian-tube and primary peritoneal): olaparib maintenance after platinum-response in 1L (SOLO1, Moore 2018) yields ~70% reduction in progression risk; niraparib (NOVA, Mirza 2016) and rucaparib (ARIEL3) extend PFS in platinum-sensitive recurrence. ESCAT IA / OncoKB Level 1. | olaparib monotherapy maintenance
niraparib monotherapy maintenance
rucaparib monotherapy maintenance
olaparib + bevacizumab (PAOLA-1, HRD+) | - SRC-NCCN-OVARIAN-2025
- SRC-ESMO-OVARIAN-2024
|
| ESCAT: clinical review pendingBIO-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
|
Primary current-line option
- Indication
- IND-OVARIAN-2L-PLAT-SENS-CARBO-GEM-BEV
- Regimen
- Carboplatin + Gemcitabine + Bevacizumab (platinum-sensitive recurrent ovarian, OCEANS regimen)
- Drugs + NSZU
- Carboplatin (DRUG-CARBOPLATIN) AUC 4 · IV day 1 every 21 days · IV ✓ NSZU covered
- Gemcitabine (DRUG-GEMCITABINE) 1000 mg/m² · IV days 1 and 8 every 21 days · IV ✓ NSZU covered
- Bevacizumab (DRUG-BEVACIZUMAB) 15 mg/kg · IV day 1 every 21 days during induction; continue as maintenance until progression · IV ✓ NSZU covered
- Reason
- Primary current-line option selected by ALGO-OVARIAN-2L at step 2; branch-driving red flag: RF-OVARIAN-BRCA-MUT-ACTIONABLE.
Other current-line alternatives (8 tracks)
Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.
- Indication
- IND-OVARIAN-2L-PLAT-SENS-CARBO-PLD-BEV
- Regimen
- Carboplatin + PLD + Bevacizumab (platinum-sensitive recurrent ovarian)
- Drugs + NSZU
- Carboplatin (DRUG-CARBOPLATIN) AUC 5 · IV day 1 every 28 days · IV ✓ NSZU covered
- Pegylated liposomal doxorubicin (DRUG-PEGYLATED-LIPOSOMAL-DOXORUBICIN) 30 mg/m² · IV day 1 every 28 days · IV ⚠ Out-of-pocket
- Bevacizumab (DRUG-BEVACIZUMAB) 10 mg/kg · IV every 14 days during induction; continue 15 mg/kg q21d as maintenance until progression · IV ✓ NSZU covered
- Reason
- Current-line alternative presented for HCP consideration
- Indication
- IND-OVARIAN-MAINT-PARPI-BRCAM-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
- Indication
- IND-OVARIAN-MAINT-PARPI-HRD-NIRAPARIB
- Regimen
- Niraparib maintenance (HRD+ recurrent platinum-sensitive ovarian, NOVA / PRIMA)
- Drugs + NSZU
- Niraparib (DRUG-NIRAPARIB) 200 mg PO daily if baseline weight <77 kg OR platelets <150 × 10⁹/L; otherwise 300 mg PO daily (individualized starting dose per Berek et al. 2018 update) · Continuous · PO ✓ NSZU covered
- Reason
- Current-line alternative presented for HCP consideration
- Indication
- IND-OVARIAN-MAINT-PARPI-RUCAPARIB
- Regimen
- Rucaparib maintenance (recurrent platinum-sensitive ovarian, ARIEL3)
- Drugs + NSZU
- Rucaparib (DRUG-RUCAPARIB) 600 mg PO BID continuous · Continuous until progression or unacceptable toxicity · PO ✗ Not registered in UA
- Reason
- Current-line alternative presented for HCP consideration
- Indication
- IND-OVARIAN-2L-PLAT-RES-MIRVETUXIMAB
- Regimen
- Mirvetuximab soravtansine (FRα-high platinum-resistant ovarian, MIRASOL)
- Drugs + NSZU
- Mirvetuximab soravtansine (DRUG-MIRVETUXIMAB-SORAVTANSINE) 6 mg/kg AIBW (adjusted ideal body weight) · IV every 21 days until progression or unacceptable toxicity · IV ✗ Not registered in UA
- Reason
- Current-line alternative presented for HCP consideration
- Indication
- IND-OVARIAN-2L-PLAT-RES-PLD-BEV
- Regimen
- PLD + Bevacizumab (platinum-resistant recurrent ovarian, AURELIA)
- Drugs + NSZU
- Pegylated liposomal doxorubicin (DRUG-PEGYLATED-LIPOSOMAL-DOXORUBICIN) 40 mg/m² · IV every 28 days · IV ⚠ Out-of-pocket
- Bevacizumab (DRUG-BEVACIZUMAB) 10 mg/kg · IV every 14 days (or 15 mg/kg every 21 days) · IV ✓ NSZU covered
- Reason
- Current-line alternative presented for HCP consideration
- Indication
- IND-OVARIAN-2L-PLAT-RES-WEEKLY-PAC-BEV
- Regimen
- Weekly Paclitaxel + Bevacizumab (platinum-resistant recurrent ovarian, AURELIA)
- Drugs + NSZU
- Paclitaxel (DRUG-PACLITAXEL) 80 mg/m² · IV days 1, 8, 15, 22 of 28-day cycle · IV ✓ NSZU covered
- Bevacizumab (DRUG-BEVACIZUMAB) 10 mg/kg · IV every 14 days (or 15 mg/kg every 21 days) · IV ✓ NSZU covered
- Reason
- Current-line alternative presented for HCP consideration
- Indication
- IND-OVARIAN-2L-PLAT-RES-TOPOTECAN
- Regimen
- Topotecan single-agent (platinum-resistant recurrent ovarian)
- Drugs + NSZU
- Topotecan (DRUG-TOPOTECAN) 4 mg/m² (weekly schedule, preferred); alternative 1.5 mg/m² IV daily × 5 days q21d (5-day schedule, more myelotoxic) · IV days 1, 8, 15 of 28-day cycle (weekly), OR daily × 5 q21d (5-day) · IV ✓ 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 1 → branch 2
- RF-OVARIAN-PLATINUM-SENSITIVE ★ winner: Platinum-sensitive ovarian relapse — Platinum-Free Interval (PFI) >6 months from last platinum dose to recurrence. Treatment-defining: re-platinum doublet (carbo + paclitaxel/PLD/gem) ± bevacizumab maintenance. PARPi maintenance after response if HRD-positive.
SRC-NCCN-OVARIAN-2025SRC-ESMO-OVARIAN-2024SRC-OCEANS-AGHAJANIAN-2012SRC-GOG0213-COLEMAN-2017
Step 2 → branch IND-OVARIAN-2L-PLAT-SENS-CARBO-GEM-BEV
- 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 | — | aggressive, palliative |
| TEST-GERMLINE-BRCA-PANEL | Germline BRCA1/2 + HRR panel sequencing | Standard | — | CSD Lab: M089 | desired (aggressive) |
Red flags — PRO / CONTRA aggressive
PRO-AGGRESSIVE
Triggers that push toward the aggressive track
- Folate receptor alpha (FRα) high expression (≥75% of viable tumor cells with ≥2+ membrane staining by VENTANA FOLR1 RxDx) in platinum-resistant high-grade serous ovarian carcinoma. Mirvetuximab soravtansine (MIRASOL — mPFS 5.6 vs 4.0 mo, OS 16.5 vs 12.7 mo vs investigator-choice chemo) is FDA-approved 2L+ ADC.
Companion diagnostic: VENTANA FOLR1 (FOLR1-2.1) RxDx Assay (Roche). Other FRα assays not validated for mirvetuximab selection. Re-biopsy at platinum-resistant progression preferred (expression can shift from primary). FRα-medium / -low…
RF-OVARIAN-FRA-HIGH-ACTIONABLESRC-NCCN-OVARIAN-2025SRC-ESMO-OVARIAN-2024SRC-MIRASOL-MOORE-2024 - 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).
EWOC-1 trial: 3-weekly carbo+pacli vs single-agent carbo for frail elderly — combination still won OS but reduced-dose acceptable. Bevacizumab caution in elderly (HTN + GI perforation risk).
RF-OVARIAN-FRAILTY-AGESRC-NCCN-OVARIAN-2025SRC-ESMO-OVARIAN-2024 - High perioperative VTE risk in ovarian cancer: ascites + bulky pelvic mass + immobilization + ovarian cancer's intrinsic prothrombotic state (~20% VTE incidence post-cytoreduction without prophylaxis). Mandates extended LMWH prophylaxis × 28 days post-op + careful timing of bevacizumab initiation (≥28 days post-op for surgical wound healing).
Khorana score >2 in ovarian = ambulatory VTE prophylaxis discussion. Bevacizumab adds bleeding risk; coordinate with surgical timing.
RF-OVARIAN-PERIOPERATIVE-VTESRC-NCCN-OVARIAN-2025SRC-ESMO-OVARIAN-2024
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-2L-PLAT-SENS-CARBO-GEM-BEV)
- Do NOT use this regimen if PFI ≤6 months (platinum-resistant — switch to AURELIA backbone)
- Do NOT skip day-8 gemcitabine reflexively for borderline cytopenias — protocol-defined reductions / G-CSF preferred over discontinuation
- Do NOT add bev if patient had Grade 3-4 bev event prior, untreated CNS mets, or major surgery within 28 days
- Do NOT skip maintenance PARPi if BRCA1/2-mutant or HRD-positive after CR/PR
Standard plan (IND-OVARIAN-2L-PLAT-SENS-CARBO-PLD-BEV)
- Do NOT use this regimen if PFI ≤6 months (platinum-resistant — switch to AURELIA backbone)
- Do NOT add bevacizumab if patient had a Grade 3-4 bev event in prior line, untreated CNS mets, or major surgery within 28 days
- Do NOT exceed cumulative anthracycline 550 mg/m² lifetime — track exposure across all anthracycline-containing lines
- Do NOT skip maintenance PARPi if BRCA1/2-mutant or HRD-positive after CR/PR — major OS-affecting omission
Aggressive plan (IND-OVARIAN-MAINT-PARPI-BRCAM-OLAPARIB)
- Do NOT start without confirmed CR or PR to platinum reinduction
- Do NOT start without documented BRCA1/2 pathogenic / likely-pathogenic variant (germline or somatic)
- Do NOT continue olaparib through Grade 3 anemia without dose reduction (300 → 250 → 200 mg BID)
- Do NOT skip pre-treatment counseling on long-term MDS/AML risk (~1-2% cumulative)
Aggressive plan (IND-OVARIAN-MAINT-PARPI-HRD-NIRAPARIB)
- Do NOT start without confirmed CR or PR to platinum reinduction
- Do NOT use 300 mg fixed starting dose if baseline weight <77 kg OR platelets <150 — start at 200 mg (Berek 2018 individualized rule)
- Do NOT continue through Grade 3-4 thrombocytopenia without dose reduction (300 → 200 → 100 mg)
- Do NOT skip pre-treatment counseling on MDS/AML risk
- Do NOT skip CBC monitoring weekly for first month
Aggressive plan (IND-OVARIAN-MAINT-PARPI-RUCAPARIB)
- Do NOT start without confirmed CR or PR to platinum reinduction
- Do NOT mistake the rucaparib transporter-mediated creatinine elevation for true nephrotoxicity (non-progressive, not a reason to stop)
- Do NOT continue through Grade 3 ALT/AST elevation with bilirubin >2× ULN — hold and dose-reduce
- Do NOT skip pre-treatment counseling on MDS/AML risk (PARPi class effect)
Aggressive plan (IND-OVARIAN-2L-PLAT-RES-MIRVETUXIMAB)
- Do NOT start without documented FRα-high (≥75% TPS at ≥2+) by VENTANA FOLR1 RxDx assay specifically — other FRα IHC assays not validated
- Do NOT start without baseline ophthalmology evaluation (slit-lamp + visual acuity)
- Do NOT skip prophylactic corticosteroid + lubricant eye drops — keratopathy is the dose-limiting AE
- Do NOT continue contact lens use during therapy
- Do NOT start in patients with active corneal disorder or pre-existing severe keratopathy
Standard plan (IND-OVARIAN-2L-PLAT-RES-PLD-BEV)
- Do NOT use this regimen if cumulative anthracycline approaches 550 mg/m² lifetime
- Do NOT add bev if patient had Grade 3-4 bev event prior, untreated CNS mets, or major surgery within 28 days
- Do NOT continue PLD through Grade 3 PPE without dose hold + reduction (40 → 30 mg/m²)
- Do NOT use platinum reinduction here — PFI ≤6 mo defines platinum-resistance
Standard plan (IND-OVARIAN-2L-PLAT-RES-WEEKLY-PAC-BEV)
- Do NOT use if Grade ≥2 residual peripheral neuropathy from prior taxane — switch to PLD arm or topotecan
- Do NOT add bev if patient had Grade 3-4 bev event prior, untreated CNS mets, or major surgery within 28 days
- Do NOT use platinum reinduction here — PFI ≤6 mo defines platinum-resistance
- Do NOT skip paclitaxel premedication (dex + diphenhydramine + ranitidine) on first cycle
Palliative plan (IND-OVARIAN-2L-PLAT-RES-TOPOTECAN)
- Do NOT use as first platinum-resistant choice if bevacizumab is available — AURELIA backbones outperform single-agent
- Do NOT use 5-day q21d schedule unless weekly is contraindicated — myelotoxicity markedly higher with no efficacy advantage
- Do NOT give if CrCl <20 (renal clearance, dose-modify CrCl 20-39)
- Do NOT continue if no response after 2-3 cycles — palliative track, change quickly
Timeline
Treatment timeline — derived from regimen + monitoring schedule
Standard plan
Induction · Carboplatin + Gemcitabine + Bevacizumab (platinum-sensitive recurrent ovarian, OCEANS regimen)
21-day cycles × 6-10 induction cycles (per OCEANS), then bevacizumab maintenance until progression / unacceptable toxicity
Standard plan
Induction · Carboplatin + PLD + Bevacizumab (platinum-sensitive recurrent ovarian)
28-day cycles × 6 induction cycles, then bevacizumab maintenance until progression / unacceptable toxicity
Aggressive plan
Induction · Mirvetuximab soravtansine (FRα-high platinum-resistant ovarian, MIRASOL)
21-day cycles × Until progression / unacceptable toxicity
Standard plan
Induction · PLD + Bevacizumab (platinum-resistant recurrent ovarian, AURELIA)
28-day cycles × Until progression or unacceptable toxicity
Standard plan
Induction · Weekly Paclitaxel + Bevacizumab (platinum-resistant recurrent ovarian, AURELIA)
28-day cycles × Until progression or unacceptable toxicity
Palliative plan
Induction · Topotecan single-agent (platinum-resistant recurrent ovarian)
28-day cycles × Until progression or unacceptable toxicity
MDT brief
Discussion questions (3, 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
OQ-BIOMARKER-BRCA1-BRCA2-GERMLINE
What is the status of BRCA1/BRCA2 germline pathogenic variant (BIO-BRCA1-BRCA2-GERMLINE)? It is required by track(s): IND-OVARIAN-MAINT-PARPI-BRCAM-OLAPARIB. Expected value: pathogenic OR likely pathogenic (germline OR somatic).
A treatment-track biomarker requirement is missing from the patient profile; the MDT should verify the test result, method, specimen, and date before relying on this option.
→ molecular_geneticist
OQ-BIOMARKER-FRA
What is the status of Folate receptor alpha (FRα / FOLR1) tumor expression (BIO-FRA)? It is required by track(s): IND-OVARIAN-2L-PLAT-RES-MIRVETUXIMAB. Expected value: high (≥75% of viable tumor cells with ≥2+ membrane staining by VENTANA FOLR1 RxDx).
A treatment-track biomarker requirement is missing from the patient profile; the MDT should verify the test result, method, specimen, and date before relying on this option.
→ pathologist
MDT talk tree (5 steps)
| # | Owner | Topic | Action |
|---|
| 1 | hematologist | Staging / disease burden | What is the current LDH? Marker of tumor burden and transformation. |
| 2 | molecular_geneticist | Biomarker status | What is the status of BRCA1/BRCA2 germline pathogenic variant (BIO-BRCA1-BRCA2-GERMLINE)? It is required by track(s): IND-OVARIAN-MAINT-PARPI-BRCAM-OLAPARIB. Expected value: pathogenic OR likely pathogenic (germline OR somatic). |
| 3 | pathologist | Biomarker status | What is the status of Folate receptor alpha (FRα / FOLR1) tumor expression (BIO-FRA)? It is required by track(s): IND-OVARIAN-2L-PLAT-RES-MIRVETUXIMAB. Expected value: high (≥75% of viable tumor cells with ≥2+ membrane staining by VENTANA FOLR1 RxDx). |
| 4 | clinical_pharmacist | Specialist review | Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication. |
| 5 | social_worker_case_manager | Specialist review | Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed. |
Skills (recommended) — for consideration (3)
- 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.
Owns: OQ-BIOMARKER-BRCA1-BRCA2-GERMLINE
- Social worker / case manager recommended
Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.
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: 1/3 known (33%), 2 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
| Missing biomarker | Label | MDT owner | Default track | Required by | Next action |
|---|
BIO-BRCA1-BRCA2-GERMLINE | BRCA1/BRCA2 germline pathogenic variant | molecular_geneticist | no | IND-OVARIAN-MAINT-PARPI-BRCAM-OLAPARIB | Verify result, method, specimen, and report date before sign-off. Expected/constraint: pathogenic OR likely pathogenic (germline OR somatic) |
BIO-FRA | Folate receptor alpha (FRα / FOLR1) tumor expression | pathologist | no | IND-OVARIAN-2L-PLAT-RES-MIRVETUXIMAB | Verify result, method, specimen, and report date before sign-off. Expected/constraint: high (≥75% of viable tumor cells with ≥2+ membrane staining by VENTANA FOLR1 RxDx) |
Technical MDT skill metadata (3/16 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 | Sign-offs | Domain |
|---|
| Cellular therapy specialist (CAR-T) | cellular_therapy_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
| Clinical pharmacist | clinical_pharmacist | v0.1.0 | 2026-04-25 | 0 | clinical_pharmacy |
| Hematologist / oncohematologist | hematologist | v0.1.0 | 2026-04-25 | 0 | hematology_oncology |
| Hematopathologist (lymphoma / leukemia / myeloma) | hematopathologist | v0.1.0 | 2026-04-25 | 0 | hematopathology |
| Infectious disease / hepatology | infectious_disease_hepatology | v0.1.0 | 2026-04-25 | 0 | infectious_diseases |
| Medical oncologist (solid-tumor chemotherapist) | medical_oncologist | v0.1.0 | 2026-04-25 | 0 | solid_oncology |
| Molecular geneticist / molecular oncologist | molecular_geneticist | v0.1.0 | 2026-04-25 | 0 | molecular_oncology |
| Palliative care | palliative_care | v0.1.0 | 2026-04-25 | 0 | palliative_care |
| Pathologist (general) | pathologist | v0.1.0 | 2026-04-25 | 0 | pathology |
| Primary care / family physician | primary_care | v0.1.0 | 2026-04-25 | 0 | primary_care |
| Psycho-oncologist | psychologist | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Radiation oncologist | radiation_oncologist | v0.1.0 | 2026-04-25 | 0 | radiation_oncology |
| Radiologist | radiologist | v0.1.0 | 2026-04-25 | 0 | diagnostic_imaging |
| Social worker / case manager | social_worker_case_manager | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Surgical oncologist | surgical_oncologist | v0.1.0 | 2026-04-25 | 0 | surgical_oncology |
| Transplant specialist (BMT) | transplant_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
Sources cited
- SRC-ARIEL3-COLEMAN-2017: Rucaparib maintenance treatment for recurrent ovarian carcinoma after response to platinum therapy (ARIEL3): a randomised, double-blind, placebo-controlled, phase 3 trial (2017)
- SRC-AURELIA-PUJADE-LAURAINE-2014: Bevacizumab combined with chemotherapy for platinum-resistant recurrent ovarian cancer: The AURELIA open-label randomized phase III trial (2014)
- SRC-ESMO-OVARIAN-2024: ESMO Ovarian Cancer Clinical Practice Guideline (2024)
- SRC-GOG0213-COLEMAN-2017: Bevacizumab and paclitaxel-carboplatin chemotherapy and secondary cytoreduction in recurrent, platinum-sensitive ovarian cancer (NRG Oncology/Gynecologic Oncology Group study GOG-0213): a multicentre, open-label, randomised, phase 3 trial (2017)
- SRC-MIRASOL-MOORE-2024: Mirvetuximab Soravtansine in FRα-Positive, Platinum-Resistant Ovarian Cancer (2024)
- SRC-NCCN-OVARIAN-2025: NCCN Ovarian Cancer (v.2.2025)
- SRC-NOVA-MIRZA-2016: Niraparib Maintenance Therapy in Platinum-Sensitive, Recurrent Ovarian Cancer (2016)
- SRC-OCEANS-AGHAJANIAN-2012: OCEANS: a randomized, double-blind, placebo-controlled phase III trial of chemotherapy with or without bevacizumab in patients with platinum-sensitive recurrent epithelial ovarian, primary peritoneal, or fallopian tube cancer (2012)
- SRC-PRIMA-GONZALEZ-MARTIN-2019: Niraparib in Patients with Newly Diagnosed Advanced Ovarian Cancer (2019)
- SRC-SOLO2-PUJADE-LAURAINE-2017: Olaparib tablets as maintenance therapy in patients with platinum-sensitive, relapsed ovarian cancer and a BRCA1/2 mutation (SOLO2/ENGOT-Ov21): a double-blind, randomised, placebo-controlled, phase 3 trial (2017)
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: 2026-08-17.
| NCT | Title | Phase | Status | Sponsor | UA | Signals | Eligibility (excerpt) |
|---|
| NCT07667192 | Reirradiation and Total Ablative Strategies for Recurrent Gynecologic Cancer | N/A | RECRUITING | — | Surrogate endpoint only Single country | |
| NCT06735326 | Fluzoparib With or Without Bevacizumab for Neoadjuvant Therapy in Advanced Ovarian Cancer | PHASE2 | RECRUITING | — | Surrogate endpoint only Single country | |
| NCT06890338 | A Study to Assess Anti-Tumor Activity of Intravenously (IV) Infused Carboplatin With Mirvetuximab Soravtansine in Participants With Newly Diagnosed Folate Receptor Alpha (FRα)Expressing Advanced-Stage Serous Epithelial Ovarian, Fallopian Tube or Primary Peritoneal Cancer. | PHASE2 | RECRUITING | — | Surrogate endpoint only Single country | |
| NCT06855706 | An Automated Personalized Physical Activity Intervention to Improve Immune Function and Clinical Outcomes in Stage II-IV Ovarian, Primary Peritoneal or Fallopian Tube Cancer and Newly Diagnosed Endometrial Cancer, Life on the Go 3 Study | NA | RECRUITING | — | Single country | |
| NCT07244835 | A Study of DEG6498 in Participants With Solid Tumors | PHASE1 | RECRUITING | — | Phase 1 only Single country | |
| NCT05721976 | With Love, Grandma ("Con Cariño, Abuelita") Pilot Study | NA | RECRUITING | — | Single country | |
| NCT06172478 | A Study of HER3-DXd in Subjects With Locally Advanced or Metastatic Solid Tumors | PHASE2 | RECRUITING | — | Surrogate endpoint only | |
| NCT03604315 | Serial Imaging of the Novel Radiotracer [^18F] FLuorthanatrace ([^18F] FTT) by PET/CTF | PHASE1 | RECRUITING | — | Phase 1 only Single country | |
| NCT03702309 | Liquid Biopsy Evaluation and Repository Development at Princess Margaret | N/A | RECRUITING | — | Single country | |
| NCT07749586 | A Study to Evaluate ARV-6723 Alone and With Pembrolizumab in Participants With Advanced Solid Tumors | PHASE1 / PHASE2 | RECRUITING | — | 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 Carboplatin + Gemcitabine + Bevacizumab (platinum-sensitive recurrent ovarian, OCEANS regimen) (REG-CARBO-GEM-BEV-OVARIAN) | ✓ registered | ✓ covered | ₴-? — verify pathway | NSZU formulary |
| Standard plan Carboplatin + PLD + Bevacizumab (platinum-sensitive recurrent ovarian) (REG-CARBO-PLD-BEV-OVARIAN) 1/3 component drug(s) not on NSZU formulary | ✓ registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
| Aggressive plan Olaparib maintenance (HRD+ ovarian post-platinum response) (REG-OLAPARIB-MAINT-OVARIAN) | ✓ registered | ✓ covered | ₴-? — verify pathway | NSZU formulary |
| Aggressive plan Niraparib maintenance (HRD+ recurrent platinum-sensitive ovarian, NOVA / PRIMA) (REG-NIRAPARIB-MAINT-OVARIAN) | ✓ registered | ✓ covered | ₴-? — verify pathway | NSZU formulary |
| Aggressive plan Rucaparib maintenance (recurrent platinum-sensitive ovarian, ARIEL3) (REG-RUCAPARIB-MAINT-OVARIAN) 1/1 component drug(s) not registered in Ukraine +1 | ✗ not registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
| Aggressive plan Mirvetuximab soravtansine (FRα-high platinum-resistant ovarian, MIRASOL) (REG-MIRVETUXIMAB-OVARIAN) 1/1 component drug(s) not registered in Ukraine +1 | ✗ not registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
| Standard plan PLD + Bevacizumab (platinum-resistant recurrent ovarian, AURELIA) (REG-PLD-BEV-OVARIAN) 1/2 component drug(s) not on NSZU formulary | ✓ registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
| Standard plan Weekly Paclitaxel + Bevacizumab (platinum-resistant recurrent ovarian, AURELIA) (REG-WEEKLY-PAC-BEV-OVARIAN) | ✓ registered | ✓ covered | ₴-? — verify pathway | NSZU formulary |
| Palliative plan Topotecan single-agent (platinum-resistant recurrent ovarian) (REG-TOPOTECAN-OVARIAN) | ✓ registered | ✓ covered | ₴-? — verify pathway | NSZU formulary |
| Trial · NCT07667192 Reirradiation and Total Ablative Strategies for Recurrent Gynecologic Cancer No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT06735326 Fluzoparib With or Without Bevacizumab for Neoadjuvant Therapy in Advanced Ovarian Cancer No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT06890338 A Study to Assess Anti-Tumor Activity of Intravenously (IV) Infused Carboplatin With Mirvetuximab Soravtansine in Participants With Newly Diagnosed Folate Receptor Alpha (FRα)Expressing Advanced-Stage Serous Epithelial Ovarian, Fallopian Tube or Primary Peritoneal Cancer. No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT06855706 An Automated Personalized Physical Activity Intervention to Improve Immune Function and Clinical Outcomes in Stage II-IV Ovarian, Primary Peritoneal or Fallopian Tube Cancer and Newly Diagnosed Endometrial Cancer, Life on the Go 3 Study No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT07244835 A Study of DEG6498 in Participants With Solid Tumors No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT05721976 With Love, Grandma ("Con Cariño, Abuelita") Pilot Study No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT06172478 A Study of HER3-DXd in Subjects With Locally Advanced or Metastatic Solid Tumors No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT03604315 Serial Imaging of the Novel Radiotracer [^18F] FLuorthanatrace ([^18F] FTT) by PET/CTF No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT03702309 Liquid Biopsy Evaluation and Repository Development at Princess Margaret No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT07749586 A Study to Evaluate ARV-6723 Alone and With Pembrolizumab in Participants With Advanced Solid Tumors 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: 2026-08-17.