Synthetic educational example. Do not self-treat: a qualified treating physician must verify the sources, patient data, contraindications, and final plan.
Patient
VERIFIED-GIST-L2-GIST_2L_SUNITINIB · Algorithm: ALGO-GIST-2L
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
- Indication
- IND-GIST-2L-SUNITINIB
- Regimen
- Sunitinib monotherapy (GIST 2L; imatinib-resistant/intolerant)
- Drugs + NSZU
- Sunitinib (DRUG-SUNITINIB) 50 mg PO once daily for 4 weeks on, 2 weeks off (4/2 schedule); continuous 37.5 mg alternative (per physician preference) · 4 weeks on / 2 weeks off (standard GIST dosing); repeat cycles until progression · PO ⚠ Out-of-pocket
- Hard contraindications
- CI-LVEF-LOW-FOR-ANTHRACYCLINE
- Reason
- Primary current-line option selected by ALGO-GIST-2L at step 2.
Sequencing / non-current-line candidates
Shown for audit and future-line context; not part of the current treatment choice.
| Indication | Authored line | Regimen | Why separated |
|---|
IND-GIST-1L-AVAPRITINIB-PDGFRA-D842V | line 1 | Avapritinib monotherapy (GIST advanced/metastatic 1L; PDGFRA D842V) | Prior-line candidate only: indication line 1, patient line 2; not a current treatment option |
Pre-treatment investigations
Investigations before treatment start · critical / standard / desired · merged across tracks
| ID | Name | Priority | Category | Where to order | Needed for |
|---|
| 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-ECHO | Echocardiography | Standard | imaging | — | all tracks |
What NOT to do
Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity
Standard plan (IND-GIST-2L-SUNITINIB)
- Do NOT use for PDGFRA D842V — sunitinib is ineffective; avapritinib preferred regardless of line
- Do NOT skip baseline echo + ECG — cardiotoxicity (LVEF decline, QTc prolongation)
- Do NOT ignore TSH monitoring — hypothyroidism in ~36% with long-term use
- Do NOT ignore BP monitoring — hypertension in ~34%; antihypertensives for G2+
- Do NOT continue without dose reduction for G3+ hand-foot syndrome (PPE)
Timeline
Treatment timeline — derived from regimen + monitoring schedule
Standard plan
Induction · Sunitinib monotherapy (GIST 2L; imatinib-resistant/intolerant)
42-day cycles × Continuous until progression
MDT brief
MDT talk tree (1 steps)
| # | Owner | Topic | Action |
|---|
| 1 | social_worker_case_manager | Specialist review | Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed. |
Skills (recommended) — for consideration (1)
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-GIST-FRAILTY-AGE, RF-GIST-HIGH-RISK-BIOLOGY, RF-GIST-INFECTION-SCREENING, RF-GIST-ORGAN-DYSFUNCTION, RF-GIST-PDGFRA-D842V, RF-GIST-TRANSFORMATION-PROGRESSION
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 | Sign-offs | Domain |
|---|
| Cellular therapy specialist (CAR-T) | cellular_therapy_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
| Clinical pharmacist | clinical_pharmacist | v0.1.0 | 2026-04-25 | 0 | clinical_pharmacy |
| Hematologist / oncohematologist | hematologist | v0.1.0 | 2026-04-25 | 0 | hematology_oncology |
| Hematopathologist (lymphoma / leukemia / myeloma) | hematopathologist | v0.1.0 | 2026-04-25 | 0 | hematopathology |
| Infectious disease / hepatology | infectious_disease_hepatology | v0.1.0 | 2026-04-25 | 0 | infectious_diseases |
| Medical oncologist (solid-tumor chemotherapist) | medical_oncologist | v0.1.0 | 2026-04-25 | 0 | solid_oncology |
| Molecular geneticist / molecular oncologist | molecular_geneticist | v0.1.0 | 2026-04-25 | 0 | molecular_oncology |
| Palliative care | palliative_care | v0.1.0 | 2026-04-25 | 0 | palliative_care |
| Pathologist (general) | pathologist | v0.1.0 | 2026-04-25 | 0 | pathology |
| Primary care / family physician | primary_care | v0.1.0 | 2026-04-25 | 0 | primary_care |
| Psycho-oncologist | psychologist | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Radiation oncologist | radiation_oncologist | v0.1.0 | 2026-04-25 | 0 | radiation_oncology |
| Radiologist | radiologist | v0.1.0 | 2026-04-25 | 0 | diagnostic_imaging |
| Social worker / case manager | social_worker_case_manager | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Surgical oncologist | surgical_oncologist | v0.1.0 | 2026-04-25 | 0 | surgical_oncology |
| Transplant specialist (BMT) | transplant_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
Sources cited
- SRC-NCCN-GIST-2025: NCCN Clinical Practice Guidelines — Gastrointestinal Stromal Tumors (GIST) (2025.v1)
Experimental options (clinical trials)
Last synced: 2026-09-09 · ctgov.
No active trials matched this scenario in ctgov.
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 Sunitinib monotherapy (GIST 2L; imatinib-resistant/intolerant) (REG-SUNITINIB-GIST-2L) 1/1 component drug(s) not on NSZU formulary | ✓ registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-09-09.