OpenOnco · Treatment Plan

Treatment plan — Glioblastoma

PLAN-VERIFIED-GBM-L2-GBM_RECURRENT_BEVACIZUMAB-V1 · v1 · 2026-07-15

Patient

VERIFIED-GBM-L2-GBM_RECURRENT_BEVACIZUMAB · Algorithm: ALGO-GBM-RECURRENT

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

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-GBM-RECURRENT-BEVACIZUMAB

Regimen

Bevacizumab for recurrent GBM

Drugs + NSZU

Bevacizumab (DRUG-BEVACIZUMAB) ✓ NSZU covered

Reason

Provisional current-line default from ALGO-GBM-RECURRENT: step 1 did not select a treatment branch. Clinical trial preferred at recurrence for all ECOG 0-2 patients. Discuss with MDT. Enroll if trial available.

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.
Mass effect emergency — dexamethasone 8-16 mg IV stat, neurosurgical consult for resection / debulking / VP shunt. Anti-epileptics for seizure cluster (levetiracetam preferred — no enzyme induction vs older AEDs that interfere with TMZ…
RF-GBM-INTRACRANIAL-PRESSURE-EMERGENCYSRC-NCCN-CNS-2025SRC-EANO-GBM-2024
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).
Pseudoprogression occurs in ~30% post-Stupp at 3 mo MRI — does not represent true tumor growth (treatment-related inflammation / radiation effect); RANO criteria require either second confirmatory MRI or outside-RT-field new disease…
RF-GBM-TRANSFORMATION-PROGRESSIONSRC-NCCN-CNS-2025SRC-EANO-GBM-2024

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-RECURRENT-BEVACIZUMAB)

Do NOT use bevacizumab with active intracranial hemorrhage
Do NOT confuse radiographic response (pseudo-response) with true tumor response — MRI signal normalization often reflects vascular normalization, not tumor kill
Do NOT delay bevacizumab due to steroid taper — both can coexist; bev may enable steroid reduction
Do NOT skip UPCR before each cycle — proteinuria can necessitate dose hold/discontinuation
Do NOT enroll in bevacizumab trials after prior bevacizumab — most trials exclude bev-pretreated patients
Do NOT add lomustine routinely without clinical trial framework — BELOB suggests modest PFS benefit but lomustine toxicity significant

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Bevacizumab for recurrent GBM

14-day cycles × Until progression or 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-CASCADE-LFS-FDR-POSITIVE, 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 (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-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)

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: 2026-07-15.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT06551909	Radioimmunotherapy in Solid Tumors (PNRR-MCNT2-2023-12378239-Aim2)	NA	RECRUITING	IRCCS San Raffaele	—	Small N (<50) Single country
NCT07285044	The Cancer Connected Access and Remote Expertise Beyond Walls Program to Provide In-Home Cancer Treatment and Improve Treatment Satisfaction in Cancer Patients Living in the Florida Panhandle and Surrounding Areas	PHASE2	RECRUITING	Mayo Clinic	—	Small N (<50) Single country
NCT03911388	HSV G207 in Children With Recurrent or Refractory Cerebellar Brain Tumors	PHASE1	RECRUITING	M.D. Anderson Cancer Center	—	Phase 1 only Small N (<50) Single country
NCT06672575	A Phase I/II Study of IVONESCIMAB in Recurrent Glioblastoma	PHASE1 / PHASE2	RECRUITING	M.D. Anderson Cancer Center	—	Small N (<50) Single country
NCT04977375	Trial of Anti-PD-1 Immunotherapy and Stereotactic Radiation in Patients With Recurrent Glioblastoma	PHASE1 / PHASE2	RECRUITING	Chirag G. Patil	—	Small N (<50) Single country
NCT07387666	Imaging Acetadote Metabolism in Glioblastoma	EARLY_PHASE1	RECRUITING	University of Texas Southwestern Medical Center	—	Small N (<50) Single country
NCT04547777	Phase 1 Trial of D2C7-IT in Combination With 2141-V11 for Recurrent Malignant Glioma	PHASE1	RECRUITING	Darell Bigner	—	Phase 1 only Single country
NCT05708352	A Phase 2 Study of the Ketogenic Diet vs Standard Anti-cancer Diet Guidance for Patients With Glioblastoma in Combination With Standard-of-care Treatment	PHASE2	RECRUITING	Cedars-Sinai Medical Center	—	Single country
NCT07426848	OT SMILE: Occupational Therapy Group Intervention for Primary Brain Tumour Patients	NA	RECRUITING	Royal College of Surgeons, Ireland	—	Single country
NCT07326566	Study of Silevertinib With Temozolomide for the Treatment of Newly Diagnosed GBM With Unmethylated MGMT and EGFRvIII	PHASE2	RECRUITING	Black Diamond Therapeutics, Inc.	—	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 Bevacizumab for recurrent GBM (REG-BEVACIZUMAB-GBM)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT06551909 Radioimmunotherapy in Solid Tumors (PNRR-MCNT2-2023-12378239-Aim2) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07285044 The Cancer Connected Access and Remote Expertise Beyond Walls Program to Provide In-Home Cancer Treatment and Improve Treatment Satisfaction in Cancer Patients Living in the Florida Panhandle and Surrounding Areas No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03911388 HSV G207 in Children With Recurrent or Refractory Cerebellar Brain Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06672575 A Phase I/II Study of IVONESCIMAB in Recurrent Glioblastoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04977375 Trial of Anti-PD-1 Immunotherapy and Stereotactic Radiation in Patients With Recurrent Glioblastoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07387666 Imaging Acetadote Metabolism in Glioblastoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04547777 Phase 1 Trial of D2C7-IT in Combination With 2141-V11 for Recurrent Malignant Glioma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05708352 A Phase 2 Study of the Ketogenic Diet vs Standard Anti-cancer Diet Guidance for Patients With Glioblastoma in Combination With Standard-of-care Treatment No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07426848 OT SMILE: Occupational Therapy Group Intervention for Primary Brain Tumour Patients No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07326566 Study of Silevertinib With Temozolomide for the Treatment of Newly Diagnosed GBM With Unmethylated MGMT and EGFRvIII 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: 2026-07-15.

plan_id: PLAN-VERIFIED-GBM-L2-GBM_RECURRENT_BEVACIZUMAB-V1 | version: 1 | generated: 2026-07-15T13:33:22.934232+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.