OpenOnco · Treatment Plan

Treatment plan — Medullary thyroid carcinoma

PLAN-VERIFIED-MTC-L1-MTC_ADVANCED_1L_CABOZANTINIB_R-V1 · v1 · 2026-07-15

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: 2026-07-15.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT01660984	Natural History Study of Children and Adults With Medullary Thyroid Cancer	N/A	RECRUITING	National Cancer Institute (NCI)	—	Single country
NCT03892993	Patient Decision Aid in Supporting Decision-Making About When to Start or Stop New Drugs, Join Clinical Trials, or Continue Active Surveillance in Patients With Medullary Thyroid Cancer and Their Caregivers	NA	RECRUITING	M.D. Anderson Cancer Center	—	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
NCT05830500	Study of Anlotinib in Patients With Advanced Medullary Thyroid Carcinoma	PHASE4	RECRUITING	Chia Tai Tianqing Pharmaceutical Group Co., Ltd.	—	Surrogate endpoint only Single country
NCT06520319	Head-to-head Study of 68Ga-MGS5 Versus 68Ga-DOTATATE PET/CT in Patients With Medullary Thyroid Carcinoma	PHASE1	RECRUITING	First Affiliated Hospital of Fujian Medical University	—	Phase 1 only Small N (<50) Single country
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
NCT07138716	Research on the Application of 68Ga-DOTA-CCK-FS PET/CT in MTC	NA	RECRUITING	Luo Yaping	—	Small N (<50) Single country
NCT07259304	Social Health, Activity Behaviors, and Quality of Life Among Young Adult Cancer Survivors	N/A	RECRUITING	University of Southern California	—	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 · NCT01660984 Natural History Study of Children and Adults With Medullary Thyroid Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03892993 Patient Decision Aid in Supporting Decision-Making About When to Start or Stop New Drugs, Join Clinical Trials, or Continue Active Surveillance in Patients With Medullary Thyroid Cancer and Their Caregivers 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 · NCT05830500 Study of Anlotinib in Patients With Advanced Medullary Thyroid Carcinoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06520319 Head-to-head Study of 68Ga-MGS5 Versus 68Ga-DOTATATE PET/CT in Patients With Medullary Thyroid Carcinoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
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 · 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 · NCT07259304 Social Health, Activity Behaviors, and Quality of Life Among Young Adult Cancer Survivors 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-MTC-L1-MTC_ADVANCED_1L_CABOZANTINIB_R-V1 | version: 1 | generated: 2026-07-15T13:33:22.940593+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.