OpenOnco · Treatment Plan

Treatment plan — Infantile fibrosarcoma

PLAN-VAR-IFS-FRAIL-V1 · v1 · 2026-05-12

Patient

VAR-IFS-FRAIL · Algorithm: ALGO-IFS-1L

DiagnosisInfantile fibrosarcoma

MOH / ICD-10C49

ICD-O-38814/3; C49

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
BIO-NTRK-FUSION	ETV6-NTRK3 fusion (defining lesion)	IA	Molecular evidence option SRC-CIVIC: Level A (Supports, Sensitivity/Response) SRC-CIVIC: Level B (Supports, Positive) Trial or research option SRC-CIVIC: Level C (Supports, Sensitivity/Response)	Infantile fibrosarcoma (IFS) is defined by ETV6-NTRK3 fusion (>90%). Larotrectinib has transformative activity (SCOUT pediatric trial, Laetsch Lancet Oncol 2018 — ORR 93% in IFS), enabling organ-sparing surgery and avoiding mutilating resection or intensive chemotherapy. Tumor-agnostic FDA approval since 2018; SCOUT data drove pediatric label.	larotrectinib monotherapy (1L for unresectable / metastatic IFS — chemotherapy-sparing) entrectinib monotherapy	SRC-FDA-CDS-2026

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-IFS-NTRK-LAROTRECTINIB

Regimen

Larotrectinib monotherapy (NTRK-fusion-positive infantile fibrosarcoma)

Drugs + NSZU

Larotrectinib (DRUG-LAROTRECTINIB) 100 mg/m² PO BID (children) / 100 mg PO BID (adults), continuous · Per regimen schedule · IV ⚠ Out-of-pocket

Reason

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

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Larotrectinib monotherapy (NTRK-fusion-positive infantile fibrosarcoma)

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

MDT brief

MDT talk tree (3 steps)

#	Owner	Topic	Action
1	molecular_geneticist	Specialist review	Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.
2	palliative_care	Specialist review	Reduced performance status / decompensated comorbidity — goals-of-care assessment needed.
3	social_worker_case_manager	Specialist review	Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.

Skills (recommended) — for consideration (3)

Molecular geneticist / molecular oncologist recommended
Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.
Palliative care recommended
Reduced performance status / decompensated comorbidity — goals-of-care assessment needed.
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: 1/1 known (100%), 0 missing, 0 default-track gaps
Unevaluated RedFlags: RF-IFS-FRAILTY-AGE, RF-IFS-INFECTION-SCREENING, RF-IFS-ORGAN-DYSFUNCTION, RF-IFS-TRANSFORMATION-PROGRESSION

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	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-NAVIGATE-DRILON-2018: Efficacy of Larotrectinib in TRK Fusion-Positive Cancers in Adults and Children (NAVIGATE / SCOUT pooled) (2018)

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: 2026-05-12.

NCT	Title	Phase	Status	Sponsor	UA	Signals	Eligibility (excerpt)
NCT04094610	A Study of Repotrectinib in Pediatric and Young Adult Subjects Harboring ALK, ROS1, OR NTRK1-3 Alterations	PHASE1 / PHASE2	RECRUITING	Turning Point Therapeutics, Inc.	—	Biomarker: enriched Surrogate endpoint only

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 Larotrectinib monotherapy (NTRK-fusion-positive infantile fibrosarcoma) (REG-LAROTRECTINIB-IFS) 1/1 component drug(s) not on NSZU formulary	✓ registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Trial · NCT04094610 A Study of Repotrectinib in Pediatric and Young Adult Subjects Harboring ALK, ROS1, OR NTRK1-3 Alterations 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: 2026-05-12.

plan_id: PLAN-VAR-IFS-FRAIL-V1 | version: 1 | generated: 2026-05-12T18:41:26.449404+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.