OpenOnco · Treatment Plan

Treatment plan — Glioblastoma

PLAN-VAR-GBM-HIGHRISK-V1 · v1 · 2026-06-27

Patient

VAR-GBM-HIGHRISK · Algorithm: ALGO-GBM-NEWLY-DIAGNOSED-1L

DiagnosisGlioblastoma

MOH / ICD-10C71

ICD-O-39440/3; C71

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-MGMT-METHYLATION	BIO definition in KB; no ESCAT BMA entry — verify with clinician

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-GBM-NEWLY-DIAGNOSED-STUPP

Regimen

Stupp protocol — Temozolomide concurrent + adjuvant

Drugs + NSZU

Temozolomide (DRUG-TEMOZOLOMIDE) Concurrent: 75 mg/m² PO daily during RT 6 weeks; Adjuvant: 150 mg/m² PO days 1-5 cycle 1 (escalate to 200 if tolerated) every 28 days × 6 cycles · Concurrent daily × 42 days then 4-week break then adjuvant cycles 1-6 · PO ✓ NSZU covered

Reason

Provisional current-line default from ALGO-GBM-NEWLY-DIAGNOSED-1L: step 1 did not select a treatment branch. IDH-mutant glioma grade 4: not GBM per WHO 2021. Manage as astrocytoma IDH-mutant (vorasidenib INDIGO). Separate disease pathway.

Other current-line alternatives (2 tracks)

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

Standard plan

Indication

IND-GBM-NEWLY-DIAGNOSED-ELDERLY-TMZ

Regimen

Temozolomide monotherapy

Drugs + NSZU

Temozolomide (DRUG-TEMOZOLOMIDE) ✓ NSZU covered

Reason

Current-line alternative presented for HCP consideration

Standard plan

Indication: IND-GBM-NEWLY-DIAGNOSED-ELDERLY-HYPORT
Regimen: Hypofractionated radiotherapy for GBM
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-IDH-MUTATION	IDH1/IDH2 mutation	Critical	histology	CSD Lab ✓ (code TBC)	all tracks
TEST-MGMT-METHYLATION	MGMT methylation	Critical	histology	CSD Lab ✓ (code TBC)	all tracks
TEST-MRI-BRAIN-CONTRAST	MRI brain with contrast	Standard	imaging	—	all tracks
TEST-NGS-COMPREHENSIVE	Comprehensive NGS tumor panel (DNA + RNA, ≥300 genes)	Desired	histology	CSD Lab: M065	desired (standard)

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Symptomatic raised intracranial pressure / mass effect in glioblastoma: declining GCS, new focal deficit, papilledema, midline shift on imaging, or seizure cluster. Mandates immediate neurosurgical / corticosteroid intervention BEFORE oncologic systemic therapy. RF-GBM-INTRACRANIAL-PRESSURE-EMERGENCY
Glioblastoma progression on or after first-line Stupp regimen: MRI evidence of true progression (RANO criteria — distinguished from pseudoprogression by serial imaging / advanced techniques), early recurrence <6 months post-RT (often pseudoprogression — repeat MRI at 4-8 weeks before re-treatment decision), or distant new lesion. Routes from upfront Stupp to recurrent-GBM algorithm (re-resection + bevacizumab / TTF / regorafenib / lomustine / re-irradiation). RF-GBM-TRANSFORMATION-PROGRESSION

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-GBM-NEWLY-DIAGNOSED-STUPP)

Do NOT delay starting RT beyond 6 weeks post-resection
Do NOT skip MGMT testing — defines elderly (≥70) regimen choice
Do NOT skip PJP prophylaxis (universal lymphopenia → opportunistic infection)
Do NOT use enzyme-inducing AEDs (phenytoin, carbamazepine) — accelerate TMZ clearance; use levetiracetam

Standard plan (IND-GBM-NEWLY-DIAGNOSED-ELDERLY-TMZ)

Do NOT use TMZ alone in MGMT-unmethylated GBM ≥70 — minimal benefit; prefer hypofractionated RT
Do NOT use full Stupp (60 Gy/30 fx) in patients ≥70 or KPS <60 — excessive toxicity
Do NOT skip MGMT testing before choosing TMZ vs RT — this is the key biomarker in elderly
Do NOT skip PJP prophylaxis (co-trimoxazole) — lymphopenia risk applies to TMZ mono too

Standard plan (IND-GBM-NEWLY-DIAGNOSED-ELDERLY-HYPORT)

Do NOT use full Stupp 60 Gy/30 fx in patients ≥70 or KPS <60 — unacceptable toxicity in elderly
Do NOT omit TMZ without first checking MGMT status — methylated patients benefit significantly
Do NOT skip MGMT testing — drives concurrent TMZ decision
Do NOT start RT without post-resection MRI (within 48h of surgery)
Do NOT delay RT beyond 6 weeks post-surgery

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Stupp protocol — Temozolomide concurrent + adjuvant

28-day cycles × Concurrent phase 6 weeks + adjuvant 6 cycles (~7 months total)

Standard plan

Induction · Temozolomide monotherapy

28-day cycles × Until progression or unacceptable toxicity; schedule per GBM protocol

MDT brief

MDT talk tree (2 steps)

#	Owner	Topic	Action
1	molecular_geneticist	Specialist review	Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.
2	radiologist	Specialist review	Imaging findings present — radiologist needed for staging/restaging.

Skills (recommended) — for consideration (2)

Molecular geneticist / molecular oncologist recommended
Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.
Radiologist recommended
Imaging findings present — radiologist needed for staging/restaging.

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-GBM-FRAILTY-AGE, RF-GBM-HIGH-RISK-BIOLOGY, RF-GBM-INFECTION-SCREENING, RF-GBM-INTRACRANIAL-PRESSURE-EMERGENCY, RF-GBM-TRANSFORMATION-PROGRESSION, RF-IATROGENIC-CRANIAL-RT-LATE-PREVENTION, RF-LI-FRAUMENI-FAMILY-HISTORY-SUSPICION

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-CCTG-CE6-PERRY-2017: Short-Course Radiation plus Temozolomide in Elderly Patients with Glioblastoma (2017)
SRC-EANO-GBM-2024: EANO Guidelines on Diagnosis and Treatment of Diffuse Gliomas of Adulthood (2024 update)
SRC-NCCN-CNS-2025: NCCN Central Nervous System Cancers (v.3.2025)
SRC-NORDIC-GBM-MALMSTROM-2012: Temozolomide versus Standard 6-Week Radiotherapy versus Hypofractionated Radiotherapy in Patients Older than 60 Years with Glioblastoma (2012)

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
NCT05720078	UNIty-Based MR-Linac Guided Adaptive RadioThErapy for High GraDe Glioma-3 (UNITED-3)	NA	RECRUITING	Sunnybrook Health Sciences Centre	—	Single country
NCT07459101	UNIty-Based MR-Linac Guided Adaptive RadioThErapy for High GraDe Glioma-4	NA	RECRUITING	Sunnybrook Health Sciences Centre	—	Single country
NCT06333899	Lorlatinib for Newly-Diagnosed High-Grade Glioma With ROS or ALK Fusion	EARLY_PHASE1	RECRUITING	Nationwide Children's Hospital	—	Small N (<50)
NCT07145047	Clinical Study of Oncolytic Virus in Glioblastoma	PHASE1 / PHASE2	RECRUITING	Mianyang Central Hospital	—	Small N (<50) Single country
NCT05768087	Escalated Dose Proton Therapy Within the Multimodality Treatment of Glioblastoma Patients	NA	RECRUITING	University of Aarhus	—	Small N (<50) Single country
NCT05432518	Pilot Trial for Treatment of Recurrent Glioblastoma	EARLY_PHASE1	RECRUITING	AHS Cancer Control Alberta	—	Small N (<50) Single country
NCT05864976	Neurosurgical Neuronavigation Using Resting State MRI and Machine Learning	N/A	RECRUITING	Washington University School of Medicine	—	Single country
NCT07195591	Beginning Radiation Immediately With GammaTile at GBM Excision Versus Standard of Care	PHASE3	RECRUITING	GT Medical Technologies, Inc.	—	Single country
NCT02800486	Super Selective Intra-arterial Repeated Infusion of Cetuximab (Erbitux) With Reirradiation for Treatment of Relapsed/Refractory GBM, AA, and AOA	PHASE2	RECRUITING	Northwell Health	—	Small N (<50) Single country
NCT07664579	Investigating the Feasibility and Acceptability of an Innovative Interdisciplinary Supportive Care Program: Couples Coping Together Against Cancer	N/A	RECRUITING	City of Hope 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 Stupp protocol — Temozolomide concurrent + adjuvant (REG-STUPP-TMZ)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Standard plan Temozolomide monotherapy (REG-TMZ-MONO)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Standard plan Hypofractionated radiotherapy for GBM (REG-HYPOFRACTIONATED-RT-GBM) No regimen components on this track — availability unknown	— unknown	— unknown	₴-? — verify pathway	not recorded
Trial · NCT05720078 UNIty-Based MR-Linac Guided Adaptive RadioThErapy for High GraDe Glioma-3 (UNITED-3) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07459101 UNIty-Based MR-Linac Guided Adaptive RadioThErapy for High GraDe Glioma-4 No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06333899 Lorlatinib for Newly-Diagnosed High-Grade Glioma With ROS or ALK Fusion No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07145047 Clinical Study of Oncolytic Virus in Glioblastoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05768087 Escalated Dose Proton Therapy Within the Multimodality Treatment of Glioblastoma Patients No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05432518 Pilot Trial for Treatment of Recurrent Glioblastoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05864976 Neurosurgical Neuronavigation Using Resting State MRI and Machine Learning No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07195591 Beginning Radiation Immediately With GammaTile at GBM Excision Versus Standard of Care No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT02800486 Super Selective Intra-arterial Repeated Infusion of Cetuximab (Erbitux) With Reirradiation for Treatment of Relapsed/Refractory GBM, AA, and AOA No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07664579 Investigating the Feasibility and Acceptability of an Innovative Interdisciplinary Supportive Care Program: Couples Coping Together Against 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-VAR-GBM-HIGHRISK-V1 | version: 1 | generated: 2026-06-27T09:41:01.552416+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.