OpenOnco · Treatment Plan

Treatment plan — Medullary thyroid carcinoma

PLAN-VERIFIED-MTC-L1-MTC_ADVANCED_1L_CABOZANTINIB_R-V1 · v1 · 2026-09-09

Patient

VERIFIED-MTC-L1-MTC_ADVANCED_1L_CABOZANTINIB_R · Algorithm: ALGO-MTC-1L

DiagnosisMedullary thyroid carcinoma

MOH / ICD-10C73

ICD-O-38345/3; C73

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

Aggressive plan

★ DEFAULT

Indication

IND-MTC-ADVANCED-1L-CABOZANTINIB-RET-WT

Regimen

Cabozantinib monotherapy (advanced/progressive RET-WT MTC, 1L; or RET-mutant where RET-selective unavailable)

Drugs + NSZU

Cabozantinib (DRUG-CABOZANTINIB) 140 mg PO once daily on empty stomach (Cometriq capsule formulation — MTC-specific) · Continuous, until progression or unacceptable toxicity · PO ✗ Not registered in UA

Reason

Primary current-line option selected by ALGO-MTC-1L at step 2.

Other current-line alternatives (1 tracks)

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

Standard plan

Indication

IND-MTC-ADVANCED-1L-SELPERCATINIB

Regimen

Selpercatinib monotherapy (advanced/progressive RET-mutant MTC, 1L)

Drugs + NSZU

Selpercatinib (DRUG-SELPERCATINIB) 160 mg PO BID with food (≥50 kg); 120 mg BID (<50 kg) · Continuous, until progression or unacceptable toxicity · PO ✗ Not registered in UA

Reason

Current-line alternative presented for HCP consideration

What NOT to do

Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity

Aggressive plan (IND-MTC-ADVANCED-1L-CABOZANTINIB-RET-WT)

Do NOT start cabozantinib without baseline + monthly BP measurement and dental evaluation (osteonecrosis-of-jaw risk).
Do NOT continue cabozantinib through GI perforation / fistula or severe hemorrhage — permanent discontinuation is required (boxed warning).
Do NOT substitute Cabometyx tablets (RCC/HCC dose 60 mg) for Cometriq capsules (MTC dose 140 mg) — they are not bioequivalent.

Standard plan (IND-MTC-ADVANCED-1L-SELPERCATINIB)

Do NOT start systemic therapy in asymptomatic, structurally stable, slowly-rising-calcitonin MTC — observe with calcitonin / CEA q3-6 mo + imaging q6-12 mo.
Do NOT use radioactive iodine (RAI) in MTC — parafollicular C-cells do not concentrate iodide; RAI has zero efficacy.
Do NOT skip germline RET testing — ~25% of MTC is hereditary; positive germline drives kindred screening + pheochromocytoma surveillance + prophylactic-thyroidectomy timing in offspring.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Aggressive plan

Induction · Cabozantinib monotherapy (advanced/progressive RET-WT MTC, 1L; or RET-mutant where RET-selective unavailable)

28-day cycles × Continuous until progression

Standard plan

Induction · Selpercatinib monotherapy (advanced/progressive RET-mutant MTC, 1L)

28-day cycles × Continuous until progression

MDT brief

Discussion questions (2, 0 blocking)

OQ-LDH-CURRENT
What is the current LDH? Marker of tumor burden and transformation.
LDH is part of the prognostic indices of indolent lymphomas.
→ hematologist
OQ-BIOMARKER-RET
What is the status of RET alterations (fusion or activating point mutation) (BIO-RET)? It is required by track(s): IND-MTC-ADVANCED-1L-SELPERCATINIB. Expected value: RET mutation positive (somatic M918T OR germline MEN2-associated C634/M918T/other).
A treatment-track biomarker requirement is missing from the patient profile; the MDT should verify the test result, method, specimen, and date before relying on this option.
→ molecular_geneticist

MDT talk tree (3 steps)

#	Owner	Topic	Action
1	hematologist	Staging / disease burden	What is the current LDH? Marker of tumor burden and transformation.
2	molecular_geneticist	Biomarker status	What is the status of RET alterations (fusion or activating point mutation) (BIO-RET)? It is required by track(s): IND-MTC-ADVANCED-1L-SELPERCATINIB. Expected value: RET mutation positive (somatic M918T OR germline MEN2-associated C634/M918T/other).
3	clinical_pharmacist	Specialist review	Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.

Skills (recommended) — for consideration (2)

Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
Molecular geneticist / molecular oncologist recommended
Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.
Owns: OQ-BIOMARKER-RET

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: 0/1 known (0%), 1 missing, 0 default-track gaps
Unevaluated RedFlags: RF-MEN2-CONFIRMED-CARRIER, RF-MEN2-FAMILY-HISTORY-SUSPICION, RF-MTC-FRAILTY-AGE, RF-MTC-HIGH-RISK-BIOLOGY, RF-MTC-INFECTION-SCREENING, RF-MTC-ORGAN-DYSFUNCTION, RF-MTC-RET-MUTANT, RF-MTC-TRANSFORMATION-PROGRESSION

Missing biomarker	Label	MDT owner	Default track	Required by	Next action
`BIO-RET`	RET alterations (fusion or activating point mutation)	molecular_geneticist	no	IND-MTC-ADVANCED-1L-SELPERCATINIB	Verify result, method, specimen, and report date before sign-off. Expected/constraint: RET mutation positive (somatic M918T OR germline MEN2-associated C634/M918T/other)

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-ONCOKB: OncoKB — Precision Oncology Knowledge Base (continuous (last verified 2026-04-25))

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: 2026-09-09.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT01109420	Clinical and Genetic Studies in Familial Non-medullary Thyroid Cancer	N/A	RECRUITING	National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)	—	Single country
NCT04216732	Natural History of Medullary Thyroid Cancer to Inform Advanced Disease Management	N/A	RECRUITING	M.D. Anderson Cancer Center	—	Single country
NCT03866382	Testing the Effectiveness of Two Immunotherapy Drugs (Nivolumab and Ipilimumab) With One Anti-cancer Targeted Drug (Cabozantinib) for Rare Genitourinary Tumors	PHASE2	RECRUITING	National Cancer Institute (NCI)	—	Surrogate endpoint only
NCT06277180	68Ga-TCR-FAPI PET/CT Guided Precision Surgery for MTC	NA	RECRUITING	Cancer Institute and Hospital, Chinese Academy of Medical Sciences	—	Single country
NCT06523582	Genetic Bases of Neuroendocrine Neoplasms in Mexican Patients	N/A	RECRUITING	Universidad Nacional Autonoma de Mexico	—	Single country
NCT07142005	Cultural Adaptation of an Educational Tool in Medullary Thyroid Cancer	N/A	RECRUITING	M.D. Anderson Cancer Center	—	Small N (<50) Single country
NCT06302569	Pembrolizumab Plus Enfortumab Vedotin in Collecting Duct and Renal Medullary Carcinoma	PHASE2	RECRUITING	Giuseppe Procopio	—	Small N (<50) Surrogate endpoint only Single country
NCT07138716	Research on the Application of 68Ga-DOTA-CCK-FS PET/CT in MTC	NA	RECRUITING	Luo Yaping	—	Small N (<50) Single country
NCT06141369	Treatment of Advanced Endocrine Tumor With Iindividualized mRNA Neoantigen Vaccine (mRNA-0523-L001)	NA	RECRUITING	Shanghai Jiao Tong University School of Medicine	—	Small N (<50) Single country
NCT03765333	GETNE Registration of Thyroid Cancer	N/A	RECRUITING	Grupo Espanol de Tumores Neuroendocrinos	—	Small N (<50) 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
Aggressive plan Cabozantinib monotherapy (advanced/progressive RET-WT MTC, 1L; or RET-mutant where RET-selective unavailable) (REG-CABOZANTINIB-MTC-1L) 1/1 component drug(s) not registered in Ukraine +1	✗ not registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Standard plan Selpercatinib monotherapy (advanced/progressive RET-mutant MTC, 1L) (REG-SELPERCATINIB-MTC-1L) 1/1 component drug(s) not registered in Ukraine +1	✗ not registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Trial · NCT01109420 Clinical and Genetic Studies in Familial Non-medullary Thyroid Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04216732 Natural History of Medullary Thyroid Cancer to Inform Advanced Disease Management No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03866382 Testing the Effectiveness of Two Immunotherapy Drugs (Nivolumab and Ipilimumab) With One Anti-cancer Targeted Drug (Cabozantinib) for Rare Genitourinary Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06277180 68Ga-TCR-FAPI PET/CT Guided Precision Surgery for MTC No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06523582 Genetic Bases of Neuroendocrine Neoplasms in Mexican Patients No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07142005 Cultural Adaptation of an Educational Tool in Medullary Thyroid Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06302569 Pembrolizumab Plus Enfortumab Vedotin in Collecting Duct and Renal Medullary Carcinoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07138716 Research on the Application of 68Ga-DOTA-CCK-FS PET/CT in MTC No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06141369 Treatment of Advanced Endocrine Tumor With Iindividualized mRNA Neoantigen Vaccine (mRNA-0523-L001) 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

Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-09-09.

plan_id: PLAN-VERIFIED-MTC-L1-MTC_ADVANCED_1L_CABOZANTINIB_R-V1 | version: 1 | generated: 2026-09-09T12:26:44.242808+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.