OpenOnco · Treatment Plan

Treatment plan — Malignant mesothelioma

PLAN-VERIFIED-MESOTHELIOMA-L2-MESOTHELIOMA_2L_NIVO-V1 · v1 · 2026-07-15

Patient

VERIFIED-MESOTHELIOMA-L2-MESOTHELIOMA_2L_NIVO · Algorithm: ALGO-MESOTHELIOMA-2L

DiagnosisMalignant mesothelioma

MOH / ICD-10C45.0

ICD-O-39050/3; C38.4, C48.1, C48.2

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-MESOTHELIOMA-2L-NIVO

Regimen

Nivolumab monotherapy (mesothelioma 2L, CONFIRM)

Drugs + NSZU

Nivolumab (DRUG-NIVOLUMAB) 240 mg IV over 30 min · Day 1 of every 14-day cycle · IV ⚠ NSZU — not for this indication

Reason

Primary current-line option selected by ALGO-MESOTHELIOMA-2L at step 1; branch-driving red flag: RF-FITNESS-ECOG-FIT.

Why this branch was chosen

Triggers from the patient profile that fired and drove the chosen branch.

Step 1 → branch IND-MESOTHELIOMA-2L-NIVO

RF-FITNESS-ECOG-FIT ★ winner: Fit performance status (ECOG 0-1): patient is fully active or restricted in physically strenuous activity but ambulatory and able to carry out light work. Eligible for full-dose chemotherapy and intensive regimens (CHOEP, BEACOPP-escalated, HD-MTX, ASCT consolidation, CAR-T). SRC-NCCN-BCELL-2025SRC-ESMO-DLBCL-2024

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-CT-CHEST-ABDOMEN-PELVIS	CT chest + abdomen + pelvis with IV contrast	Critical	imaging	—	all tracks
TEST-HBV-SEROLOGY	Hepatitis B Serology Panel (HBsAg, anti-HBc total, anti-HBs)	Critical	lab	—	all tracks
TEST-HCV-ANTIBODY	HCV Antibody	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-CORTISOL-MORNING	Morning cortisol	Standard	lab	—	desired (standard)
TEST-PFT-SPIROMETRY	Pulmonary function tests / spirometry	Standard	clinical_assessment	—	desired (standard)
TEST-TSH	Thyroid-stimulating hormone	Standard	lab	—	all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Active TB OR latent TB conversion risk — ICI may trigger TB reactivation; pre-treatment IGRA / TST + chest imaging recommended.
Ukraine is an HBV/HCV/TB high-prevalence region — pre-ICI screen more important than in low-prevalence settings. HBV reactivation risk handled by RF-UNIVERSAL-HBV-REACTIVATION-RISK.
RF-NSCLC-INFECTION-SCREENINGSRC-NCCN-NSCLC-2025SRC-ESMO-NSCLC-METASTATIC-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-MESOTHELIOMA-2L-NIVO)

Do not assess response with standard RECIST 1.1 — MPM requires modified RECIST (bidimensional pleural measurement)
Do not administer nivolumab for active autoimmune disease requiring systemic immunosuppression >10 mg/d prednisone equivalent
Do not omit baseline HBV/HCV serology + thyroid function (TSH) + LFTs before first dose
Do not use in prior organ transplant recipients or active immune pneumonitis from prior ICI therapy

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Nivolumab monotherapy (mesothelioma 2L, CONFIRM)

14-day cycles × Up to 24 cycles (approximately 12 months per CONFIRM protocol)

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-OCC-ASBESTOS-MALIGNANCY-PREVENTION, RF-OCC-FIREFIGHTER-PREVENTION

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-CONFIRM-FENNELL-2021: Nivolumab versus placebo in patients with relapsed malignant mesothelioma (CONFIRM): a multicentre, double-blind, randomised, phase 3 trial (2021)
SRC-NCCN-NSCLC-2025: NCCN Clinical Practice Guidelines — Non-Small Cell Lung Cancer (2025.v8)

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
NCT06051695	A Study to Evaluate the Safety and Efficacy of Mesothelin-Targeting Logic-gated CAR T, in Participants With Solid Tumors That Express MSLN and Have Lost HLA-A*02 Expression	PHASE1 / PHASE2	RECRUITING	A2 Biotherapeutics Inc.	—	Surrogate endpoint only Single country
NCT07443020	Fast TILs to Treat Metastatic Pleural Effusions From Epithelial or Mesothelial Primary Tumors	PHASE1	RECRUITING	Allegheny Singer Research Institute (also known as Allegheny Health Network Research Institute)	—	Phase 1 only Small N (<50) Single country
NCT04847063	Individual Response to Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Treatment of Peritoneal Carcinomatosis From Peritoneal Mesothelioma or Atypical Mesothelial Proliferation or From Ovarian, Colorectal, or Appendiceal Histologies	PHASE1	RECRUITING	National Cancer Institute (NCI)	—	Phase 1 only Surrogate endpoint only Single country
NCT06996249	Prospective Data Collection Initiative on Thoracic Malignancies	N/A	RECRUITING	Dutch Society of Physicians for Pulmonology and Tuberculosis	—	Surrogate endpoint only Single country
NCT05655078	Hemithoracic Irradiation With Proton Therapy in Malignant Pleural Mesothelioma	NA	RECRUITING	University College, London	—	Single country
NCT05628376	TRAcking Thoracic Cancer Evolution Through Therapy (Rx) EVO	N/A	RECRUITING	University College, London	—	Single country
NCT06444815	A Study of VET3-TGI in Patients With Solid Tumors	PHASE1	RECRUITING	KaliVir Immunotherapeutics	—	Phase 1 only Single country
NCT03683680	Prospectively Collected Pleural Biopsies for Validation of Malignant Pleural Mesothelioma Prognostic Biomarkers	NA	RECRUITING	Dana-Farber Cancer Institute	—	Single country
NCT07330271	PTC-Guided Therapy for Peritoneal Mesothelioma	NA	RECRUITING	Beijing Tsinghua Chang Gung Hospital	—	Single country
NCT07403630	INTEGRATIVE "MULTI-OMICS" AND FUNCTIONAL PLATFORM FOR THE COMPLETE DIAGNOSTIC CHARACTERIZATION OF TUMORS: THE ITALIAN TUMOR CHEMOGENOMIC PROFILER (IT-TCP)	NA	RECRUITING	Azienda Ospedaliero-Universitaria di Parma	—	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 Nivolumab monotherapy (mesothelioma 2L, CONFIRM) (REG-NIVO-MONO-MESOTHELIOMA-2L)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT06051695 A Study to Evaluate the Safety and Efficacy of Mesothelin-Targeting Logic-gated CAR T, in Participants With Solid Tumors That Express MSLN and Have Lost HLA-A*02 Expression No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07443020 Fast TILs to Treat Metastatic Pleural Effusions From Epithelial or Mesothelial Primary Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04847063 Individual Response to Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Treatment of Peritoneal Carcinomatosis From Peritoneal Mesothelioma or Atypical Mesothelial Proliferation or From Ovarian, Colorectal, or Appendiceal Histologies No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06996249 Prospective Data Collection Initiative on Thoracic Malignancies No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05655078 Hemithoracic Irradiation With Proton Therapy in Malignant Pleural Mesothelioma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05628376 TRAcking Thoracic Cancer Evolution Through Therapy (Rx) EVO No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06444815 A Study of VET3-TGI in Patients With Solid Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03683680 Prospectively Collected Pleural Biopsies for Validation of Malignant Pleural Mesothelioma Prognostic Biomarkers No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07330271 PTC-Guided Therapy for Peritoneal Mesothelioma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07403630 INTEGRATIVE "MULTI-OMICS" AND FUNCTIONAL PLATFORM FOR THE COMPLETE DIAGNOSTIC CHARACTERIZATION OF TUMORS: THE ITALIAN TUMOR CHEMOGENOMIC PROFILER (IT-TCP) 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-MESOTHELIOMA-L2-MESOTHELIOMA_2L_NIVO-V1 | version: 1 | generated: 2026-07-15T13:33:22.909979+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.