OpenOnco · Treatment Plan

Treatment plan — Anaplastic thyroid carcinoma

PLAN-VAR-THYROID-ANAPLASTIC-FRAIL-V1 · v1 · 2026-05-13

Patient

VAR-THYROID-ANAPLASTIC-FRAIL · Algorithm: ALGO-THYROID-ANAPLASTIC-1L

DiagnosisAnaplastic thyroid carcinoma

MOH / ICD-10C73

ICD-O-38021/3; C73

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-BRAF-V600E	Excluded (negative)

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-ATC-PACLITAXEL-CARBOPLATIN

Regimen

Paclitaxel + carboplatin (ATC, palliative 1L)

Drugs + NSZU

Paclitaxel (DRUG-PACLITAXEL) Paclitaxel 175 mg/m² · Per regimen schedule · IV ✓ NSZU covered
Carboplatin (DRUG-CARBOPLATIN) carboplatin AUC 5 IV q3w · Per regimen schedule · IV ⚠ NSZU — not for this indication

Reason

Provisional current-line default from ALGO-THYROID-ANAPLASTIC-1L: step 3 did not select a treatment branch. BRAF wild-type + ECOG ≥3: best supportive care. ATC prognosis is extremely poor without effective therapy; palliative/hospice goals of care discussion.

Other current-line alternatives (1 tracks)

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

Standard plan

Indication

IND-ATC-BRAF-V600E-DAB-TRAM

Regimen

Dabrafenib + trametinib (anaplastic thyroid carcinoma, BRAF V600E)

Drugs + NSZU

Dabrafenib (DRUG-DABRAFENIB) 150 mg PO BID (approximately every 12 hours) · Continuous daily; fasting state (no food 1h before, 2h after) · PO ⚠ NSZU — not for this indication
Trametinib (DRUG-TRAMETINIB) 2 mg PO QD · Continuous daily; fasting state (same timing window as dabrafenib or 1-2h before) · PO ⚠ 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-BRAF-V600E-MUTATION	BRAF V600E mutation test	Critical	genomic	—	all tracks
TEST-CBC	Complete Blood Count with Differential	Critical	lab	—	all tracks
TEST-CMP	Comprehensive Metabolic Panel	Critical	lab	—	all tracks
TEST-LFT	Liver Function Tests (ALT, AST, bilirubin, ALP, GGT, albumin)	Critical	lab	—	all tracks
TEST-BRAIN-MRI-CONTRAST	Brain MRI with contrast	Standard	—	—	desired (standard)
TEST-CT-NECK-THORAX-ABDOMEN-PELVIS	CT neck/thorax/abdomen/pelvis	Standard	imaging	—	all tracks
TEST-ECG-BASELINE	Baseline electrocardiogram	Standard	clinical_assessment	—	all tracks
TEST-LVEF-ECHO	Echocardiogram with LVEF	Standard	clinical_assessment	—	all tracks
TEST-OPHTHALMOLOGIC-EXAM	Ophthalmologic examination	Standard	clinical_assessment	—	all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Age ≥75 with ECOG ≥2 or ≥2 comorbidities — cisplatin-paclitaxel CRT poorly tolerated and curative-intent surgical resection often not feasible; for BRAF-mutant ATC, dabrafenib + trametinib monotherapy (without RT or surgery) is reasonable; for BRAF-wild-type frail patients, palliative-intent care + tracheostomy for airway management is often the appropriate path. ATC frailty assessment must integrate with palliative-care planning given short median OS. RF-THYROID-ANAPLASTIC-FRAILTY-AGE
Active or latent infection requiring resolution / prophylaxis before initiating cisplatin / paclitaxel / doxorubicin chemoradiation, dabrafenib + trametinib, larotrectinib / entrectinib, or selpercatinib for ATC: HBsAg-positive (HBV reactivation on cytotoxic + targeted), anti-HBc-positive (occult HBV), HIV-positive (ART coordination, CYP3A4 interactions with TKIs), or active TB. Disease tempo limits ability to fully resolve infection — pragmatic prophylaxis approach required. RF-THYROID-ANAPLASTIC-INFECTION-SCREENING
Baseline organ dysfunction precluding standard cisplatin / paclitaxel / doxorubicin chemoradiation or affecting BRAF-MEK-inhibitor dosing in ATC: CrCl <30 mL/min (cisplatin contraindicated), LVEF <50% (doxorubicin contraindicated; trametinib cardiac monitoring), bilirubin >3× ULN (BRAFi/MEKi hepatic clearance), QTc >480 ms (dabrafenib QT signal), or compromised airway from tumor (tracheostomy or stent required before systemic therapy initiation). RF-THYROID-ANAPLASTIC-ORGAN-DYSFUNCTION

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-ATC-BRAF-V600E-DAB-TRAM)

НІКОЛИ не призначати дабрафеnoб без траметиnoбу — монотерапія BRAFi при BRAF V600E ATC викликає парадоксальну активацію MAPK та може прискорити ріст пухлини
Не відкладати тестування BRAF V600E — іnoціювати в день отримання матеріалу біопсії (RAID-протокол); ATC — швидко прогресуюча хвороба
Не призначати при BRAF V600 дикого типу або не-V600E мутації (BRAF клас 2/3) — інша мішень, BRAFi неефективний
Не починати при QTc >500 мс або LVEF нижче нижньої межі норми — кардіологічна оцінка обов'язкова перед початком
Не пропускати дерматологічний огляд кожno 4-8 тижnoв — шкірний плоскоклітинний рак / кератоакантома є класовим ефектом BRAFi
Не відкладати хірургічну консультацію при хорошій відповіді — мета неоад'ювантної терапії: конверсія до резектабельності

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Paclitaxel + carboplatin (ATC, palliative 1L)

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

Standard plan

Induction · Dabrafenib + trametinib (anaplastic thyroid carcinoma, BRAF V600E)

28-day cycles × Continue until disease progression or unacceptable toxicity; responses can be durable (mDOR ~9 mo)

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	palliative_care	Specialist review	Reduced performance status / decompensated comorbidity — goals-of-care assessment needed.

Skills (recommended) — for consideration (2)

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.

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-ATC-BRAF-V600E-ACTIONABLE, RF-THYROID-ANAPLASTIC-FRAILTY-AGE, RF-THYROID-ANAPLASTIC-HIGH-RISK-BIOLOGY, RF-THYROID-ANAPLASTIC-INFECTION-SCREENING, RF-THYROID-ANAPLASTIC-ORGAN-DYSFUNCTION, RF-THYROID-ANAPLASTIC-TRANSFORMATION-PROGRESSION

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-NCCN-THYROID-2025: NCCN Clinical Practice Guidelines — Thyroid Carcinoma (2025.v2)
SRC-ROAR-SUBBIAH-2018: Dabrafenib and Trametinib Treatment in Patients with Locally Advanced or Metastatic BRAF V600–Mutant Anaplastic Thyroid Cancer ()

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: 2026-05-13.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT06374602	Efficacy of Pembrolizumab and Lenvatinib in Patients With Anaplastic Thyroid Cancer	PHASE2	RECRUITING	Saint Petersburg State University, Russia	—	Small N (<50) Surrogate endpoint only Single country
NCT07068542	Sacituzumab Tirumotecan Combined With Immunotherapy in Advanced Thyroid Cancer	NA	RECRUITING	Zhejiang Provincial People's Hospital	—	Single country
NCT06362694	Study of the Rechallenge Concept in Patients With BRAF-positive Anaplastic Thyroid Cancer After Progression on Anti-BRAF Therapy	PHASE2	RECRUITING	Saint Petersburg State University, Russia	—	Small N (<50) Surrogate endpoint only Single country
NCT06639191	[177Lu]Lu-AKIR001 First-in-human Study	EARLY_PHASE1	RECRUITING	Karolinska University Hospital	—	Small N (<50) Single country
NCT03765333	GETNE Registration of Thyroid Cancer	N/A	RECRUITING	Grupo Espanol de Tumores Neuroendocrinos	—	Small N (<50) Single country
NCT03975231	Dabrafenib, Trametinib, and IMRT in Treating Patients With BRAF Mutated Anaplastic Thyroid Cancer	PHASE1	RECRUITING	City of Hope Medical Center	—	Phase 1 only Small N (<50) Single country
NCT06007924	A Study of Avutometinib and Defactinib in People With Thyroid Cancer	PHASE2	RECRUITING	Memorial Sloan Kettering Cancer Center	—	Small N (<50) Surrogate endpoint only Single country
NCT07181720	CD70-Targeted CAR-T Therapy in CD70-Positive Advanced Solid Tumors	PHASE1	RECRUITING	Chongqing Precision Biotech Co., Ltd	—	Phase 1 only Single country
NCT06902376	XL092 and Cemiplimab in BRAF WT Thyroid Cancer	PHASE1	RECRUITING	UNC Lineberger Comprehensive Cancer Center	—	Phase 1 only Small N (<50) Single country
NCT06235216	Sacituzumab govitEcan in THYroid Cancers	PHASE2	RECRUITING	Grupo Espanol de Tumores Neuroendocrinos	—	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 Paclitaxel + carboplatin (ATC, palliative 1L) (REG-PACLITAXEL-CARBOPLATIN-ATC)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Standard plan Dabrafenib + trametinib (anaplastic thyroid carcinoma, BRAF V600E) (REG-DAB-TRAM-ATC)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT06374602 Efficacy of Pembrolizumab and Lenvatinib in Patients With Anaplastic Thyroid Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07068542 Sacituzumab Tirumotecan Combined With Immunotherapy in Advanced Thyroid Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06362694 Study of the Rechallenge Concept in Patients With BRAF-positive Anaplastic Thyroid Cancer After Progression on Anti-BRAF Therapy No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06639191 [177Lu]Lu-AKIR001 First-in-human Study No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03765333 GETNE Registration of Thyroid Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03975231 Dabrafenib, Trametinib, and IMRT in Treating Patients With BRAF Mutated Anaplastic Thyroid Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06007924 A Study of Avutometinib and Defactinib in People With Thyroid Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07181720 CD70-Targeted CAR-T Therapy in CD70-Positive Advanced Solid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06902376 XL092 and Cemiplimab in BRAF WT Thyroid Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06235216 Sacituzumab govitEcan in THYroid Cancers 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: 2026-05-13.

plan_id: PLAN-VAR-THYROID-ANAPLASTIC-FRAIL-V1 | version: 1 | generated: 2026-05-13T10:01:52.733547+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.