OpenOnco · Treatment Plan

Treatment plan — Renal cell carcinoma

PLAN-VAR-RCC-RELAPSED-V1 · v1 · 2026-06-27

Patient

VAR-RCC-RELAPSED · Algorithm: ALGO-RCC-METASTATIC-2L

DiagnosisRenal cell carcinoma

MOH / ICD-10C64

ICD-O-38312/3; C64.9

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-VHL-STATUS	BIO definition in KB; no ESCAT BMA entry — verify with clinician

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-RCC-METASTATIC-2L-BELZUTIFAN

Regimen

Belzutifan monotherapy (VHL-disease tumors / mRCC 2L+)

Drugs + NSZU

Belzutifan (DRUG-BELZUTIFAN) 120 mg PO once daily, continuous · Continuous until progression or unacceptable toxicity · PO ✗ Not registered in UA

Reason

Primary current-line option selected by ALGO-RCC-METASTATIC-2L at step 1.

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

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Solitary kidney OR baseline CrCl <50 mL/min — limits cisplatin alternatives + impacts surveillance imaging.RF-RCC-ORGAN-DYSFUNCTION
CNS metastases — ICI doublet retains intracranial activity; cabozantinib + nivolumab also CNS-active.RF-RCC-TRANSFORMATION-PROGRESSION

CONTRA-AGGRESSIVE

Hard contraindications to escalation

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Belzutifan monotherapy (VHL-disease tumors / mRCC 2L+)

28-day cycles × Until progression / unacceptable 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-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISK, RF-BAP1-CONFIRMED-CARRIER, RF-BAP1-FAMILY-HISTORY-SUSPICION, RF-COWDEN-CONFIRMED-CARRIER, RF-COWDEN-FAMILY-HISTORY-SUSPICION, RF-HLRCC-CONFIRMED-CARRIER, RF-HLRCC-FAMILY-HISTORY-SUSPICION, RF-HPRC-CONFIRMED-CARRIER, RF-HPRC-FAMILY-HISTORY-SUSPICION, RF-LIFESTYLE-OBESITY-CANCER-PREVENTION, RF-RCC-FRAILTY-AGE, RF-RCC-HIGH-RISK-BIOLOGY, RF-RCC-IMDC-INTERMEDIATE-POOR-RISK, RF-RCC-INFECTION-SCREENING, RF-RCC-ORGAN-DYSFUNCTION, RF-RCC-TRANSFORMATION-PROGRESSION, RF-SDH-CONFIRMED-CARRIER, RF-SDH-FAMILY-HISTORY-SUSPICION, RF-VHL-FAMILY-HISTORY-SUSPICION

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-ESMO-RCC-2024: ESMO Renal Cell Carcinoma (2024)
SRC-NCCN-KIDNEY-2025: NCCN Kidney Cancer (2025.v3)

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
NCT05917106	Renal Cancer Monitoring Based on ctDNA Methylomics: A Prospective Cohort Study (MEMORY Study)	N/A	RECRUITING	Jinling Hospital, China	—	Single country
NCT05387863	Decision Aid (DA) for Renal Patients	NA	RECRUITING	NYU Langone Health	—	Small N (<50) Single country
NCT00722228	Autologous and Allogeneic Whole Cell Cancer Vaccine for Metastatic Tumors	PHASE1 / PHASE2	RECRUITING	Hadassah Medical Organization	—	Single country
NCT06722807	ClAmpless, Sutureless PartIAl Nephrectomy for Renal Masses	NA	RECRUITING	University of Florida	—	Single country
NCT06708949	A Randomized Phase 2 Trial of Nivolumab, Relatlimab Plus Ipilimumab vs. Nivolumab Plus Ipilimumab in First-line Advanced Renal Cell Carcinoma (RCC)	PHASE2	RECRUITING	M.D. Anderson Cancer Center	—	Small N (<50) Single country
NCT05752552	Study to Determine the Safety and Pharmacokinetics of DO-2 in Patients With Advanced or Refractory Solid Tumours	PHASE1	RECRUITING	DeuterOncology	—	Phase 1 only
NCT06995664	Partial Volume High-Dose Irradiation in Renal Cell Carcinoma for Intra-TUmoural Control ALongside Current Management	NA	RECRUITING	Royal Marsden NHS Foundation Trust	—	Small N (<50) Single country
NCT07223424	Patient Preference for Subcutaneous vs. Intravenous Immune Therapy	PHASE2	RECRUITING	Diwakar Davar	—	Single country
NCT06349642	Immune Checkpoint Inhibitor Response in Solid Tumors Using a Live Tumor Diagnostic Platform	N/A	RECRUITING	Mayo Clinic	—	Single country
NCT06447103	An Investigational Scan (89Zr-DFO-GmAb PET/CT) Compared to Contrast-Enhanced CT for the Detection of Recurrent Clear Cell Renal Cell Cancer After Surgery Comparing Carbonic Anhydrase IX (CAIX) PET CT to Conventional PET CT for Post-Op Staging in Kidney Cancer	PHASE2	RECRUITING	Jonsson Comprehensive Cancer 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 Belzutifan monotherapy (VHL-disease tumors / mRCC 2L+) (REG-BELZUTIFAN-MONO) 1/1 component drug(s) not registered in Ukraine +1	✗ not registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Trial · NCT05917106 Renal Cancer Monitoring Based on ctDNA Methylomics: A Prospective Cohort Study (MEMORY Study) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05387863 Decision Aid (DA) for Renal Patients No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT00722228 Autologous and Allogeneic Whole Cell Cancer Vaccine for Metastatic Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06722807 ClAmpless, Sutureless PartIAl Nephrectomy for Renal Masses No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06708949 A Randomized Phase 2 Trial of Nivolumab, Relatlimab Plus Ipilimumab vs. Nivolumab Plus Ipilimumab in First-line Advanced Renal Cell Carcinoma (RCC) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05752552 Study to Determine the Safety and Pharmacokinetics of DO-2 in Patients With Advanced or Refractory Solid Tumours No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06995664 Partial Volume High-Dose Irradiation in Renal Cell Carcinoma for Intra-TUmoural Control ALongside Current Management No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07223424 Patient Preference for Subcutaneous vs. Intravenous Immune Therapy No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06349642 Immune Checkpoint Inhibitor Response in Solid Tumors Using a Live Tumor Diagnostic Platform No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06447103 An Investigational Scan (89Zr-DFO-GmAb PET/CT) Compared to Contrast-Enhanced CT for the Detection of Recurrent Clear Cell Renal Cell Cancer After Surgery Comparing Carbonic Anhydrase IX (CAIX) PET CT to Conventional PET CT for Post-Op Staging in Kidney 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-RCC-RELAPSED-V1 | version: 1 | generated: 2026-06-27T09:41:02.305987+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.