OpenOnco · Treatment Plan

Treatment plan — Small cell lung cancer

PLAN-VAR-SCLC-FRAIL-V1 · v1 · 2026-06-27

Patient

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

DiagnosisSmall cell lung cancer

MOH / ICD-10C34

ICD-O-38041/3; C34.9

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
No clinically actionable variants matched in this profile.

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-SCLC-EXTENSIVE-1L

Regimen

Etoposide-platinum + durvalumab (extensive SCLC, 1L)

Drugs + NSZU

Carboplatin (DRUG-CARBOPLATIN) AUC 5-6 IV · Day 1 of 21-day cycle x 4 cycles · IV ✓ NSZU covered
Etoposide (DRUG-ETOPOSIDE) 80-100 mg/m² IV · Days 1, 2, 3 of 21-day cycle x 4 cycles · IV ✓ NSZU covered
Durvalumab (DRUG-DURVALUMAB) 1500 mg IV q3 weeks (induction); 1500 mg q4 weeks (maintenance) · From cycle 1; maintenance until progression · IV ⚠ NSZU — not for this indication

Supportive care

SUP-G-CSF-PRIMARY-PROPHYLAXIS-PROSTATE

Reason

Primary current-line option selected by ALGO-SCLC-1L at step 1.

Other current-line alternatives (2 tracks)

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

Standard plan

Indication

IND-SCLC-LIMITED-1L

Regimen

Etoposide-platinum + concurrent thoracic RT (limited SCLC)

Drugs + NSZU

Cisplatin (DRUG-CISPLATIN) 75 mg/m² IV · Day 1 of 21-day cycle x 4 cycles · IV ✓ NSZU covered
Etoposide (DRUG-ETOPOSIDE) 100 mg/m² IV · Days 1, 2, 3 of 21-day cycle x 4 cycles · IV ✓ NSZU covered

Supportive care

SUP-G-CSF-PRIMARY-PROPHYLAXIS-PROSTATE

Reason

Current-line alternative presented for HCP consideration

Standard plan

Indication

IND-SCLC-LS-CONSOLIDATION-DURVA

Regimen

Durvalumab consolidation post-CRT (LS-SCLC)

Drugs + NSZU

Durvalumab (DRUG-DURVALUMAB) 1500 mg IV q4 weeks · Up to 24 months OR until progression / unacceptable toxicity · IV ⚠ NSZU — not for this indication

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-CECT-CAP	CECT chest/abdomen/pelvis	Critical	imaging	—	all tracks
TEST-BRAIN-MRI-CONTRAST	Brain MRI with contrast	Standard	—	—	all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Patient with active or incompletely controlled pre-existing autoimmune or inflammatory disease (sarcoidosis, rheumatoid arthritis, IBD, SLE, autoimmune hepatitis, inflammatory myopathy, myasthenia gravis, or similar) is considered for immune checkpoint inhibitor (ICI) therapy — elevated risk of immune-related adverse events (irAE) flare or de-novo grade 3-4 irAE. Requires specialist (rheumatology / pulmonology / gastroenterology) pre-treatment review; prefer lower-irAE-burden backbone when options exist (pembrolizumab mono > ipilimumab+nivolumab). RF-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISK
Age ≥75 + ECOG ≥2 OR significant comorbidity — concurrent CRT (limited-stage) poorly tolerated; sequential CRT or single-agent palliative chemo considered.RF-SCLC-FRAILTY-AGE

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-SCLC-LS-CONSOLIDATION-DURVA)

Do NOT start durvalumab in patients with progression after CRT — ADRIATIC excluded such patients; benefit not shown
Do NOT start consolidation after SEQUENTIAL (not concurrent) CRT — ADRIATIC enrolled only cCRT; no evidence for sCRT
Do NOT continue through Grade ≥3 immune pneumonitis — permanent discontinuation; pneumonitis risk additive on prior thoracic RT
Do NOT delay start beyond 42 days post-CRT completion (protocol upper limit)

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Etoposide-platinum + durvalumab (extensive SCLC, 1L)

21-day cycles × EP × 4; durva maintenance until progression

Standard plan

Induction · Etoposide-platinum + concurrent thoracic RT (limited SCLC)

21-day cycles × 4-6 cycles concurrent with thoracic RT (60 Gy/30 fx once-daily OR 45 Gy/30 fx BID)

Standard plan

Induction · Durvalumab consolidation post-CRT (LS-SCLC)

28-day cycles × Up to 24 months consolidation post-concurrent CRT

MDT brief

MDT talk tree (1 steps)

#	Owner	Topic	Action
1	palliative_care	Specialist review	Reduced performance status / decompensated comorbidity — goals-of-care assessment needed.

Skills (recommended) — for consideration (1)

Palliative care recommended
Reduced performance status / decompensated comorbidity — goals-of-care assessment needed.

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-LIFESTYLE-TOBACCO-CANCER-PREVENTION, RF-OCC-ASBESTOS-MALIGNANCY-PREVENTION, RF-OCC-DIESEL-EXHAUST-PREVENTION, RF-OCC-FIREFIGHTER-PREVENTION, RF-OCC-IONIZING-RADIATION-PREVENTION, RF-OCC-PAH-PREVENTION, RF-OCC-PAINTERS-PREVENTION, RF-OCC-SILICA-PREVENTION, RF-RADON-MALIGNANCY-PREVENTION, RF-SCLC-BRAIN-METS-EMERGENCY, RF-SCLC-FRAILTY-AGE, RF-SCLC-HIGH-RISK-BIOLOGY, RF-SCLC-INFECTION-SCREENING, RF-SCLC-ORGAN-DYSFUNCTION, RF-SCLC-PARANEOPLASTIC, RF-SCLC-SVC-SYNDROME

Technical MDT skill metadata (1/16 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-ADRIATIC-CHENG-2024: Durvalumab after Chemoradiotherapy in Limited-Stage Small-Cell Lung Cancer (2024)
SRC-ESMO-SCLC-2021: ESMO Clinical Practice Guideline on Small Cell Lung Cancer (2021)
SRC-NCCN-SCLC-2025: NCCN Clinical Practice Guidelines — Small Cell Lung 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
NCT06422143	Pembrolizumab With or Without Maintenance Sacituzumab Tirumotecan (Sac-TMT; MK-2870) in Metastatic Squamous Non-small Cell Lung Cancer (NSCLC) [MK-2870-023]	PHASE3	RECRUITING	Merck Sharp & Dohme LLC	—	—
NCT04136535	Pemetrexed and Carboplatin With or Without Anlotinib Hydrochloride for Osimertinib-resistant Non-squamous NSCLC	PHASE2	RECRUITING	Fudan University	—	Surrogate endpoint only Single country
NCT06494540	NIS to Examine the Effectiveness of TDC in Patients With Metastatic Non-squamous NSCLC and High-risk Genetic Alterations	N/A	RECRUITING	AstraZeneca	—	Single country
NCT04699838	Chemo-Immunotherapy Followed by Durvalumab and Ceralasertib in Treatment Naïve Patients With Extensive Stage Small Cell Lung Cancer	PHASE2	RECRUITING	Muhammad Furqan	—	Small N (<50) Surrogate endpoint only Single country
NCT07356544	Observational, Prospective, Multi-centric Study Exploring HER2 Mutations Incidence and Therapeutic Management in aNSCLC	N/A	RECRUITING	Gruppo Oncologico Italiano di Ricerca Clinica	—	Single country
NCT06476093	SRT Combined With Anlotinib for the Treatment of Brain Metastases From Non-small Cell Lung Cancer	NA	RECRUITING	The First People's Hospital of Lianyungang	—	Small N (<50) Surrogate endpoint only Single country
NCT06755684	Neoadjuvant Befotertinib Combined Bevacizumab or Platinum-based Double Chemotherapy for Resectable Locally-advanced EGFR Mutation-positive Non-Small Cell Lung Cancer	PHASE2	RECRUITING	Peng Zhang	—	Single country
NCT06102928	A Clinical Study of the Combination of Anlotinib and Aumolertinib in the First-line Treatment of Advanced NSCLC With EGFR 21L858R Mutation	NA	RECRUITING	Kunming Medical University	—	Small N (<50) Surrogate endpoint only Single country
NCT02838836	Tumor Cell and DNA Detection in the Blood, Urine and Bone Marrow of Patients With Solid Cancers	N/A	RECRUITING	University of Missouri-Columbia	—	Surrogate endpoint only Single country
NCT06552234	Phase II Efficacy Study of Repotrectinib in Frail and/or Elderly Patients With ROS1-rearranged Advanced NSCLC	PHASE2	RECRUITING	Centre Hospitalier Intercommunal de Toulon La Seyne sur Mer	—	Small N (<50) 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 Etoposide-platinum + durvalumab (extensive SCLC, 1L) (REG-EP-DURVA-SCLC)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Standard plan Etoposide-platinum + concurrent thoracic RT (limited SCLC) (REG-EP-CONCURRENT-RT-SCLC-LIMITED)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Standard plan Durvalumab consolidation post-CRT (LS-SCLC) (REG-DURVA-CONSOLIDATION-SCLC)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT06422143 Pembrolizumab With or Without Maintenance Sacituzumab Tirumotecan (Sac-TMT; MK-2870) in Metastatic Squamous Non-small Cell Lung Cancer (NSCLC) [MK-2870-023] No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04136535 Pemetrexed and Carboplatin With or Without Anlotinib Hydrochloride for Osimertinib-resistant Non-squamous NSCLC No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06494540 NIS to Examine the Effectiveness of TDC in Patients With Metastatic Non-squamous NSCLC and High-risk Genetic Alterations No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04699838 Chemo-Immunotherapy Followed by Durvalumab and Ceralasertib in Treatment Naïve Patients With Extensive Stage Small Cell Lung Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07356544 Observational, Prospective, Multi-centric Study Exploring HER2 Mutations Incidence and Therapeutic Management in aNSCLC No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06476093 SRT Combined With Anlotinib for the Treatment of Brain Metastases From Non-small Cell Lung Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06755684 Neoadjuvant Befotertinib Combined Bevacizumab or Platinum-based Double Chemotherapy for Resectable Locally-advanced EGFR Mutation-positive Non-Small Cell Lung Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06102928 A Clinical Study of the Combination of Anlotinib and Aumolertinib in the First-line Treatment of Advanced NSCLC With EGFR 21L858R Mutation No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT02838836 Tumor Cell and DNA Detection in the Blood, Urine and Bone Marrow of Patients With Solid Cancers No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06552234 Phase II Efficacy Study of Repotrectinib in Frail and/or Elderly Patients With ROS1-rearranged Advanced NSCLC 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-SCLC-FRAIL-V1 | version: 1 | generated: 2026-06-27T09:41:02.326672+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.