OpenOnco · Treatment Plan

Treatment plan — Papillary thyroid carcinoma

PLAN-SHOWCASE-THYROID-RET-001-V1 · v1 · 2026-10-18

Patient

SHOWCASE-THYROID-RET-001 · Algorithm: ALGO-THYROID-PAPILLARY-1L

DiagnosisPapillary thyroid carcinoma

MOH / ICD-10C73

ICD-O-38260/3; C73

StageIV

Histologypapillary thyroid carcinoma

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
ESCAT: clinical review pendingBIO-RET	fusion (CCDC6-RET, NCOA4-RET, ELKS-RET et al.) — distinct from MTC mutations	IB	Molecular evidence option SRC-CIVIC: Level A (Supports, Sensitivity/Response) SRC-CIVIC: Level B (Supports, Sensitivity/Response) Resistance or avoidance signal SRC-CIVIC: Level C ⚠ Resistance Trial or research option SRC-CIVIC: Level C (Supports, Sensitivity/Response)	RET fusion in papillary thyroid carcinoma (PTC) — ~5-10% sporadic, enriched in radiation-induced PTC. Selpercatinib (LIBRETTO-001 PTC cohort, Wirth 2020 — ORR 79%) and pralsetinib (ARROW PTC cohort, ORR 89%) are FDA-approved for RAI-refractory advanced disease. Selective RET-TKIs are preferred over sorafenib / lenvatinib for RET-fusion-positive RAI-refractory disease.	selpercatinib monotherapy (RAI-refractory advanced disease) pralsetinib monotherapy	SRC-NCCN-CNS-2025

⚠️ Not included in plan

Biomarker	Status
BRAF	Excluded (negative)
NTRK	Excluded (negative)

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-THYROID-PAPILLARY-RAI-REFRACTORY-LENVATINIB

Regimen

Lenvatinib monotherapy (RAI-refractory progressive PTC, 1L systemic)

Drugs + NSZU

Lenvatinib (DRUG-LENVATINIB) 24 mg PO daily, continuous · Per regimen schedule · IV ⚠ NSZU — not for this indication

Reason

Primary current-line option selected by ALGO-THYROID-PAPILLARY-1L at the fallback path.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Lenvatinib monotherapy (RAI-refractory progressive PTC, 1L systemic)

21-day cycles × 6 cycles or until progression / toxicity

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-AUTOIMMUNE-THYROIDITIS-LYMPHOMA-PREVENTION, RF-COWDEN-CONFIRMED-CARRIER, RF-COWDEN-FAMILY-HISTORY-SUSPICION, RF-OCC-IONIZING-RADIATION-PREVENTION, RF-THYROID-PAPILLARY-FRAILTY-AGE, RF-THYROID-PAPILLARY-HIGH-RISK-BIOLOGY, RF-THYROID-PAPILLARY-INFECTION-SCREENING, RF-THYROID-PAPILLARY-ORGAN-DYSFUNCTION, RF-THYROID-PAPILLARY-TRANSFORMATION-PROGRESSION, RF-WERNER-CONFIRMED-CARRIER

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-NCCN-THYROID-2025: NCCN Clinical Practice Guidelines — Thyroid Carcinoma (2025.v2)

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: 2026-10-18 · ClinicalTrials.gov.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT06791005	A Clinical Study on the Benefits of Carbon Nanoparticles Injection Time in Patients With Thyroid Cancer.	PHASE3	RECRUITING	Second Affiliated Hospital of Xi'an Jiaotong University	—	Surrogate endpoint only Single country
NCT07545837	Health and Wellness Coaching to Improve Adherence to Healthy Habits and Treatment Plans in Papillary and Follicular Thyroid Cancer Survivors	NA	RECRUITING	Mayo Clinic	—	Small N (<50) Single country
NCT06082180	A Prospective, Open-label, Multicenter, Randomized Controlled Phase III Study of Prophylactic Central Neck Dissection in Low-risk Papillary Thyroid Cancer	PHASE3	RECRUITING	Cancer Institute and Hospital, Chinese Academy of Medical Sciences	—	Single country
NCT06133374	Concordance of Molecular Classification Based on Fine Needle Biopsy (FNB) and Surgical Samples	N/A	RECRUITING	University of Calgary	—	Single country
NCT05024929	Targeted Therapy to Increase RAI Uptake in Metastatic DTC	N/A	RECRUITING	Children's Hospital of Philadelphia	—	Small N (<50)
NCT07376837	Radiofrequency Ablation for Curative Treatment of Small Low-Risk Papillary Thyroid Cancer: Pilot Study	NA	RECRUITING	University Health Network, Toronto	—	Small N (<50) Single country
NCT06333587	Minimally Invasive Treatments of the Thyroid	N/A	RECRUITING	European Institute of Oncology	—	Single country
NCT06623578	Comparative Study of Transaxillary Robotic Thyroidectomy With MRND Versus Conventional Open Surgery in N1b PTC	NA	RECRUITING	Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University	—	Surrogate endpoint only Single country
NCT05766098	Definition of Mutational Profile of Papillary Thyroid Tumors by Mass-ARRAY	N/A	RECRUITING	Istituto Auxologico Italiano	—	Single country
NCT06554652	Selective Neck Dissection Versus Modified Neck Dissection in PTC	PHASE3	RECRUITING	Fudan University	—	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 Lenvatinib monotherapy (RAI-refractory progressive PTC, 1L systemic) (REG-LENVATINIB-THYROID-RAI-REF)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT06791005 A Clinical Study on the Benefits of Carbon Nanoparticles Injection Time in Patients With Thyroid Cancer. No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07545837 Health and Wellness Coaching to Improve Adherence to Healthy Habits and Treatment Plans in Papillary and Follicular Thyroid Cancer Survivors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06082180 A Prospective, Open-label, Multicenter, Randomized Controlled Phase III Study of Prophylactic Central Neck Dissection in Low-risk Papillary Thyroid Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06133374 Concordance of Molecular Classification Based on Fine Needle Biopsy (FNB) and Surgical Samples No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05024929 Targeted Therapy to Increase RAI Uptake in Metastatic DTC No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07376837 Radiofrequency Ablation for Curative Treatment of Small Low-Risk Papillary Thyroid Cancer: Pilot Study No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06333587 Minimally Invasive Treatments of the Thyroid No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06623578 Comparative Study of Transaxillary Robotic Thyroidectomy With MRND Versus Conventional Open Surgery in N1b PTC No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05766098 Definition of Mutational Profile of Papillary Thyroid Tumors by Mass-ARRAY No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06554652 Selective Neck Dissection Versus Modified Neck Dissection in PTC 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. Table assembled: 2026-10-18. Table assembly does not verify registration, NSZU coverage or prices. Check the currency of these data separately.

plan_id: PLAN-SHOWCASE-THYROID-RET-001-V1 | version: 1 | generated: 2026-10-18T12:08:12.170370+00:00

Project intended-use limits (CHARTER §11 + §15): Outpatient oncology treatment planning to support tumor-board discussion. For independent clinician review; not for autonomous clinical decision-making.

Project intended-use limits (CHARTER §11 + §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.